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  • 1. Augutis, M
    et al.
    Abel, R
    Richard, Levi
    Pediatric spinal cord injury in a subset of European countries.2006Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 44, nr 2, s. 106-12Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: Postal survey.

    SETTING: A total of 19 countries in Europe.

    OBJECTIVES: Firstly, to collect information about incidence and systems of care for pediatric spinal cord injury (pedSCI); including prevention, initial care and follow-up in a subset of European countries. Secondly, to initiate a network of involved professionals for exchange of information and development of research and care programs.

    METHODS: A short semi-structured questionnaire was sent to respondents working with spinal cord injury (SCI) in 19 countries in Europe.

    RESULTS: Only in Portugal and Sweden, is the incidence of pedSCI (fatal injuries included) established, that is 27 children/million children/year and 4.6 children/million children/year, respectively. For the other countries, the estimated incidence of pedSCI (nonfatal injuries) varied from 0.9 to 21.2 children/million children/year in the age group of 0-14 years. Although the incidence varies considerably, pedSCI is rare throughout Europe. The management differs between the countries depending on the age of the child and the local organization of health care.

    CONCLUSIONS: The survey confirms that pedSCI is rare. In order to establish high-quality standardized care, further integration of knowledge in this area is needed throughout Europe. The contacts initiated by this survey may be used to create an international network serving as a reference for health professionals, researchers and families, thereby possibly alleviating some of the unwanted variations of care identified in this study.

  • 2. Augutis, M
    et al.
    Malker, H
    Richard, Levi
    Pediatric spinal cord injury in Sweden; how to identify a cohort of rare events.2003Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 41, nr 6, s. 337-46Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: Register study enhanced and verified by medical records and personal interviews and examinations.

    SETTINGS: Sweden.

    OBJECTIVES: To define a method of identifying a study population of rare events. To point out the relative importance of every step, an example is given of identifying persons who sustained traumatic spinal cord injury (SCI) in childhood.

    METHODS: Cases were identified in seven steps that all needed to be fulfilled, from definition of selection criteria through combination of several data sources, to the use of several verification methods.

    RESULTS: Initial screening by registers identified 384 possible cases, which however were found by subsequent analysis to include a large number of incorrect cases. At completion of all analytic steps, 35 living cases could be fully verified and 14 deceased cases could be partially verified.

    CONCLUSIONS: Registers offer a practical initial source for study population identification. The screening of International Classification of Diseases codes defining SCI only included less than 30% of 'true' SCIs. Subsequently, further refinement and quality control is necessary in order to ensure validity. Such further verification is time-consuming, but nevertheless necessary in order to verify a true cohort.

  • 3. Augutis, M
    et al.
    Richard, Levi
    Pediatric spinal cord injury in Sweden: incidence, etiology and outcome.2003Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 41, nr 6, s. 328-36Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: Retrospective descriptive study.

    OBJECTIVES: To assess incidence, causes and early outcome of traumatic spinal cord injury (SCI) among children in Sweden, thereby identifying high-risk groups and situations as a basis for preventative measures and improved care.

    METHODS: Data from population registers, County Habilitation Centers as well as from informal sources were used to estimate the incidence of SCI in Sweden during the years 1985-1996 among children aged 0-15 years. Contacts with the treating hospitals, reviews of medical records and/or personal interviews were used to verify primary data. In total, 92 children were thus identified.

    RESULTS: The incidence was found to be 4.6/million children/year (95% CI 3.6-5.5). When excluding prehospital fatalities, the incidence was 2.4 (95% CI 1.8-3.1). The main cause of injury among fatalities was traffic accidents. Associated injuries occurred in 41% of the children. Among survivors (10-15 years), sports-related injuries (43%) were as common a cause as traffic accidents (39%). The survivors were treated in 18 different hospitals.

    CONCLUSION: Pediatric SCI in Sweden is rare, presumably because of effective primary prevention. Preventative measures should be further differentiated for each age group of children in accordance with their differing risk profiles. In contrast to the effective preventative measures that have been implemented in Sweden, care of these patients is still too fractionated and decentralized for sufficient specialization to emerge.

  • 4. Augutis, Marika
    et al.
    Richard, Levi
    Asplund, Kenneth
    Berg-Kelly, Kristina
    Psychosocial aspects of traumatic spinal cord injury with onset during adolescence: a qualitative study.2007Inngår i: Journal of Spinal Cord Medicine (JSCM), ISSN 1079-0268, E-ISSN 2045-7723, Vol. 30 Suppl 1, s. S55-64Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND/OBJECTIVE: Spinal cord injury (SCI) occurring during adolescence poses additional challenges because of the concurrent age-specific bio-psychosocial development. Full understanding of the psychosocial dimensions of rehabilitation requires exploration of the patient perspective. The objective of this study was to focus on psychosocial factors from the patient perspective in persons who had previously sustained a SCI during early and mid-adolescence (11-15 years of age).

    METHODS: Twenty-four of the 28 persons who had sustained a SCI in Sweden from 1985 to 1996 participated in the study. Semistructured interviews were made an average of 10 years after injury. Narratives were analyzed qualitatively according to content analysis.

    RESULTS: Parents and peers were found to have formed a crucial network. Parents frequently acted as advocates in interactions with health care providers, as supporters, and as containers of sorrow, frustration, and anger. Peers acted as promoters of activity and identity development. However, health care providers were perceived as not making sufficient use of this network.

    CONCLUSIONS: Rehabilitation professionals might be encouraged to increase their knowledge of adolescence medicine to better meet the specific needs and demands of persons in this age group. It is further suggested that parents and peers be considered important partners in the joint rehabilitation effort.

  • 5.
    Awad, Amar
    et al.
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Lindgren, Lenita
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Hultling, Claes
    Department of Neurobiology, Care Sciences and Society (Neurorehabilitation), Karolinska Institute, Stockholm, Sweden.
    Westling, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi.
    Nyberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Eriksson, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB), Fysiologi. Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Preserved somatosensory conduction in a patient with complete cervical spinal cord injury2015Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, nr 5, s. 426-431Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Neurophysiological investigation has shown that patients with clinically complete spinal cord injury can have residual motor sparing ("motor discomplete"). In the current study somatosensory conduction was assessed in a patient with clinically complete spinal cord injury and a novel ethodology for assessing such preservation is described, in this case indicating "sensory discomplete" spinal cord injury. Methods: Blood oxygenation level-dependent functional magnetic resonance imaging (BOLD fMRI) was used to examine the somatosensory system in a healthy subject and in a subject with a clinically complete cervical spinal cord injury, by applying tactile stimulation above and below the level of spinal cord injury, with and without visual feedback. Results: In the participant with spinal cord injury, somatosensory stimulation below the neurological level of the lesion gave rise to BOLD signal changes in the corresponding areas of the somatosensory cortex. Visual feedback of the stimulation strongly modulated the somatosensory BOLD signal, implying that cortico-cortical rather than spino-cortical connections can drive activity in the somatosensory cortex. Critically, BOLD signal change was also evident when the visual feedback of the stimulation was removed, thus demonstrating sensory discomplete spinal cord injury. Conclusion: Given the existence of sensory discomplete spinal cord injury, preserved but hitherto undetected somatosensory conduction might contribute to the unexplained variability related to, for example, the propensity to develop decubitus ulcers and neuropathic pain among patients with clinically complete spinal cord injury.

  • 6. Divanoglou, A
    et al.
    Richard, Levi
    Incidence of traumatic spinal cord injury in Thessaloniki, Greece and Stockholm, Sweden: a prospective population-based study.2009Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 47, nr 11, s. 796-801Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: Prospective population-based open-ended study. This paper is part of the Stockholm-Thessaloniki Acute Traumatic Spinal Cord Injury Study.

    OBJECTIVES: To calculate incidence and evaluate the epidemiological profile of the incident population with traumatic spinal cord injury (TSCI).

    SETTINGS: The greater Thessaloniki region in Greece and the greater Stockholm region in Sweden.

    METHODS: TSCI individuals, older than 15 years of age, who had survived the first 7 days post-trauma, were identified through an active surveillance system. The forms of the Nordic Spinal Cord Injury Registry were used.

    RESULTS: 87 individuals were injured in the greater Thessaloniki and 49 in the greater Stockholm region. Annual crude incidence was 33.6 per million for Thessaloniki and 19.5 per million for the Stockholm region. The leading causes of injury for the Thessaloniki region were transportation accidents (51%) and falls (37%), and those for the Stockholm region were falls (47%) and transportation accidents (23%). A significantly larger number of individuals of the Thessaloniki group were injured in transportation accidents. There was no significant difference between regions with regard to the type of resulting impairment.

    CONCLUSIONS: Incidence of TSCI was considerably higher in the Thessaloniki region as compared with that in the Stockholm region, probably chiefly reflecting differences in preventative measures with regard to driving.

  • 7. Divanoglou, A
    et al.
    Westgren, N
    Bjelak, S
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Medical conditions and outcomes at 1 year after acute traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study2010Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 48, nr 6, s. 470-476Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS).

    OBJECTIVES: To evaluate and compare outcomes, length of stay (LOS), associated conditions and medical complications at 1-year post-trauma.

    SETTINGS: The Greater Thessaloniki region, Greece, and the Greater Stockholm region, Sweden. While Stockholm follows a SCI system of care, Thessaloniki follows a fragmented 'non-system' approach.

    SUBJECTS: Out of the 87 cases in Thessaloniki and the 49 cases in Stockholm who comprised the study population of STATSCIS, 75 and 42 cases respectively were successfully followed-up during the first year post-trauma.

    RESULTS: Significantly superior outcomes (that is, survival with neurological recovery, functional ability and discharge to home) and shorter LOS for initially motor complete cases occurred in Stockholm. Management routines known to increase long-term morbidity, for example, long-term tracheostomy and indwelling urethral catheters were significantly more common in Thessaloniki. Major medical complications, that is, multiple pressure ulcers, heterotopic ossification and bacteremia/sepsis were more frequent in Thessaloniki.

    CONCLUSIONS: Our findings show how two rather similar cohorts of TSCI manifest large discrepancies in terms of 1-year outcomes and complications, depending on the type of management they receive. As the major difference between regions was the presence or absence of a SCI system of care, rather than differences in availability of modern medicine, the mere presence of the latter does not seem to be sufficient to guarantee adequate outcomes. This study provides strong evidence as to the urgent need of implementing a SCI system of care in Greece.

  • 8.
    Divanoglou, Anestis
    et al.
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Seiger, A
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Richard, Levi
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm.
    Acute management of traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study.2010Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 48, nr 6, s. 477-482Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS). OBJECTIVES: To characterize patient populations and to compare acute management after traumatic spinal cord injury (TSCI). SETTINGS: The Greater Thessaloniki region in Greece and the Greater Stockholm region in Sweden. METHODS: Inception cohorts with acute TSCI that were hospitalized during the study period, that is September 2006 to October 2007, were identified. Overall, 81 out of 87 cases consented to inclusion in Thessaloniki and 47 out of 49 in Stockholm. Data from Thessaloniki were collected through physical examinations, medical record reviews and communication with TSCI cases and medical teams. Data from Stockholm were retrieved from the Nordic Spinal Cord Injury Registry. RESULTS: There were no significant differences between study groups with regard to core clinical characteristics. In contrast, there were significant differences in (1) transfer logistics from the scene of trauma to a tertiary-level hospital (number of intermediate admissions, modes of transportation and duration of transfer) and (2) acute key therapeutic interventions, that is, the use of mechanical ventilation (49% in Thessaloniki versus 20% in Stockholm), and performance of tracheostomy (36% in Thessaloniki versus 15% in Stockholm); spinal surgery was performed significantly more often and earlier in Stockholm than in Thessaloniki. CONCLUSIONS: Despite largely similar core clinical characteristics, Stockholm and Thessaloniki cases underwent significantly different acute management, most probably to be attributed to adaptations to the differing regional approaches of care one following a systematic approach of SCI care and the other not.

  • 9.
    Divanoglou, Anestis
    et al.
    Karolinska Inst, Div Neurorehabil, Stockholm.
    Westgren, Ninni
    Karolinska Inst, Div Neurorehabil, Stockholm ; Karolinska Univ Hosp, Spinalis SCI Rehabil Unit, Stockholm.
    Seiger, Åke
    Karolinska Inst, Div Neurorehabil, Stockholm.
    Hulting, Claes
    Karolinska Inst, Div Neurorehabil, Stockholm ; Karolinska Univ Hosp, Spinalis SCI Rehabil Unit, Stockholm.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Karolinska Inst, Div Neurorehabil, Stockholm ; Rehab Stn Stockholm, Stockholm, Sweden.
    Late mortality during the first year after acute traumatic spinal cord injury: a prospective, population-based study2010Inngår i: Journal of Spinal Cord Medicine (JSCM), ISSN 1079-0268, E-ISSN 2045-7723, Vol. 33, nr 2, s. 117-127Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Little is known about the possible impact of the system of care on mortality during the first year after acute traumatic spinal cord injury (TSCI).

    OBJECTIVE: To evaluate late mortality (i.e., >7 days after trauma) during the first year after acute TSCI in 2 European Union (EU) regions, Thessaloniki in Greece and Stockholm in Sweden.

    METHODS: This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS), which is a prospective, population-based study. Incidence cohorts of TSCI cases were identified and followed up in both study regions through STATSCIS. Data from Thessaloniki region were collected through physical examination, medical records review, and interviews with TSCI individuals and the medical teams. Data from Stockholm were retrieved mainly from the Nordic Spinal Cord Injury Registry, as well as from direct contact with all intensive care facilities of the region.

    RESULTS: The annual case mortality rate after acute TSCI was nearly 20% in Thessaloniki and 0% in Stockholm. The mean time of survival after trauma for the 12 mortality cases of Thessaloniki was 47 days (median = 24, SD +/- 67, range = 8-228). Factors associated with mortality were higher age and presence of comorbid spinal disorders but also the inefficient transfer logistics, initially missed spinal instability, and unsuccessfully treated complications.

    CONCLUSIONS: The annual case mortality rate in Thessaloniki was dramatically higher than in Stockholm. The different approaches to care, one systematic and the other not, is postulated to be an important factor leading to such major discrepancies between the outcomes of these 2 EU regions.

  • 10.
    Ekbom, K.
    et al.
    Söder Hospital, Karolinska Institute, Stockholm, Sweden.
    Waldenlind, E.
    Söder Hospital, Karolinska Institute, Stockholm, Sweden.
    Richard, Levi
    Söder Hospital, Karolinska Institute, Stockholm, Sweden.
    Andersson, B.
    Gãvle Hospital, Gãvle, Sweden.
    Boivie, J.
    University Hospital, Linköping, Sweden.
    Dizdar, N.
    University Hospital, Linköping, Sweden.
    Bousser, M.G.
    Hôpital St. Antoine, Paris, France.
    Tehindrazanirivelo, A.
    Hôpital St. Antoine, Paris, France.
    Lutz, G.
    Hôpital St. Antoine, Paris, France.
    Hannerz, J.
    Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
    Hardebo, J.E.
    University Hospital, Lund. Sweden.
    Henry, P.
    Hôpital Pellegrin—Tripode, Bordeaux, France.
    Rosazza, M.
    Hôpital Pellegrin—Tripode, Bordeaux, France.
    Krabbe, A.
    Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
    Kinnman, J.
    Halmstad Hospital, Halmstad, Sweden.
    Persson, L.I.
    Sahlgrenska Hospital, University of University of Gothenburg, Gothenburg, Sweden.
    Prusinski, A.
    Neurology Clinic, Medical Academy, Lodz, Poland.
    Durko, A.
    Neurology Clinic, Medical Academy, Lodz, Poland.
    Kozubski, W.
    Neurology Clinic, Medical Academy, Lodz, Poland.
    Rozniecki, M.D.
    Neurology Clinic, Medical Academy, Lodz, Poland.
    Wysocka-Bakowska, M.M.
    Neurology Clinic, Medical Medical Academy, Warsaw, Poland.
    Cole, J.A.
    Glaxo Group Research Ltd., Greenford, Middlesex. United Kingdom.
    Patel, P.
    Glaxo Group Research Ltd., Greenford, Middlesex. United Kingdom.
    Pilgrim, AJ.
    Glaxo Group Research Ltd., Greenford, Middlesex. United Kingdom.
    Winter, O'B.
    Glaxo Group Research Ltd., Greenford, Middlesex. United Kingdom.
    Donoghue, S.
    Glaxo Group Research Ltd., Greenford, Middlesex. United Kingdom.
    Treatment of acute cluster headache with sumatriptan1991Inngår i: New England Journal of Medicine, ISSN 0028-4793, E-ISSN 1533-4406, nr 325, s. 322-326Artikkel i tidsskrift (Fagfellevurdert)
  • 11.
    Engman Bredvik, Sofie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Carballeira Suarez, Nivia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri. Umeå University Hospital.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Nilsson, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri. Umeå University Hospital.
    Multi-family therapy in anorexia nervosa: a qualitative study of parental experiences2016Inngår i: Innovations in family therapy for eating disorders: novel treatment developments, patient insights, and the role of carers / [ed] Stuart Murray, Leslie Anderson, and Leigh Cohn, New York: Routledge, 2016, s. 236-248Kapittel i bok, del av antologi (Fagfellevurdert)
  • 12.
    Engman-Bredvik, Sofie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Carballeira Suarez, Nivia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Nilsson, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Multi-family therapy in anorexia nervosa: a qualitative study of parental experiences2016Inngår i: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 24, nr 2, s. 186-197Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This qualitative study from northern Sweden investigated experiences of multi-family therapy (MFT) in 12 parents of children with anorexia nervosa (AN). The main reported benefit was the opportunity to talk to others in a similar situation, thereby sharing experiences and struggles. MFT resulted in new perspectives and insights that improved family dynamics and enabled new constructive behaviors. In conclusion, MFT seems to be a useful therapeutic modality in the treatment of AN in a northern European setting.

  • 13. Falci, S
    et al.
    Holtz, A
    Akesson, E
    Azizi, M
    Ertzgaard, P
    Hultling, C
    Kjaeldgaard, A
    Richard, Levi
    Ringden, O
    Westgren, M
    Lammertse, D
    Seiger, A
    Obliteration of a posttraumatic spinal cord cyst with solid human embryonic spinal cord grafts: first clinical attempt.1997Inngår i: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 14, nr 11, s. 875-84Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Cystic lesions of the spinal cord (syringomyelia) may occur after spinal cord injury. Posttraumatic syringomyelia may result in a myelopathy causing symptoms of sensory and motor loss, as well as worsening spasticity, pain, hyperhidrosis, and autonomic dysreflexia. Shunting of the cyst cavity along with untethering of the scarred spinal cord is widely accepted as the treatment of choice. However, the long-term stabilization of the progressive myelopathy caused by a posttraumatic cyst is suboptimal because of arachnoidal rescarring, shunt tube blockage, and cyst reexpansion. A new neurosurgical strategy to overcome the complication of cyst reexpansion was designed. Experimental studies have shown the successful use of embryonic spinal cord grafts, including human grafts, to obliterate induced spinal cord cavities in rats. The authors report the first use of solid human embryonic spinal cord grafts to successfully obliterate 6 cm of a large cyst cavity in a patient becoming myelopathic from a posttraumatic cyst. The grafts are well visualized by MRI to the 7-month postoperative follow-up and cyst obliteration is seen in the region where the grafts were placed.

  • 14.
    Flank, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Boström, Carina
    Lewis, John E.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Wahman, Kerstin
    Self-reported physical activity and risk markers for cardiovascular disease after spinal cord injury2014Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, nr 9, s. 886-890Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective:

    To examine whether self-reported physical activity of a moderate/vigorous intensity influences risk markers for cardiovascular disease in persons with paraplegia due to spinal cord injury.

    Design:

    Descriptive, cross-sectional study.

    Subjects:

    A total of 134 wheelchair-dependent individuals (103 men, 31 women) with chronic (>= 1 year) post-traumatic spinal cord injury with paraplegia.

    Methods:

    Cardiovascular disease markers (hypertension, blood glucose and a blood lipid panel) were analysed and related to physical activity.

    Results:

    One out of 5 persons reported undertaking physical activity >= 30 min/day. Persons who were physically active >= 30 min/day were significantly younger than inactive persons. Systolic and diastolic blood pressures were lower in the physically active group. When adjusting for age, the association between systolic blood pressure and physical activity disappeared. Physical activity >= 30 min/day had a tendency to positively influence body mass index and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. Men had significantly higher systolic and diastolic blood pressures than women, lower high-density lipoprotein cholesterol, higher low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and higher triglycerides. No other significant differences between men and women were found.

    Conclusion:

    Self-reported physical activity >= 30 min/day in persons with spinal cord injury positively influenced diastolic blood pressure. No other reductions in cardiovascular disease risk markers were seen after controlling for age. These results indicate a positive effect of physical activity, but it cannot be concluded that recommendations about physical activity in cardiovascular disease prevention for the general population apply to wheelchair-dependent persons with spinal cord injury.

  • 15.
    Flank, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Ramnemark, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Wahman, Kerstin
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Dyslipidemia is common after spinal cord injury - independent of clinical measures2015Inngår i: Jacobs Journal of Physical Rehabilitation Medicine, ISSN 2469-3103, Vol. 1, nr 1Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To survey the incidence of clinical risk markers and its correlation with established clinical measurements for cardiovascular disease (CVD) in a heterogeneous spinal cord injured (SCI) patient population.

    Design: Descriptive, cross-sectional study.

    Subjects: 78 patients with SCI, at different injury and functional level.

    Methods: Anthropometric data, blood pressure, a blood lipid panel, blood glucose and a questionnaire were analyzed.

    Results: Eighty-one percent of all patients had dyslipidemia (DL) and a majority of the patients with abdominal measures below the recommended cut-off levels had DL. Self-reported physical activity above the cut-off level was reported by 32.1%of the patients. There were no differences in clinical measures, serum lipid values and blood glucose between physically active and not active patients. No differences were seen between men/women, tetraplegia/paraplegia and wheelchair dependent/not wheelchair dependent patients.

    Conclusion: DL is common and seems to be not treated or undertreated in the studied SCI patient group with different neurological lesion and functional levels. General anthropometric clinical measures do not seem to be valid for evaluating risk for CVD in this patient group.

  • 16.
    Flank, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Ramnemark, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Wahman, Kerstin
    Department of Neurobiology, Care Sciences and Society, Division of Neurodegeneration, Section Neurorehabilitation, Karolinska Institutet, Sweden; Rehab Station, Stockholm/Spinalis R&D Unit, Sweden.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Pain, anxiety and depression in spinal cord injured patients2017Inngår i: Jacobs Journal of Physical Rehabilitation Medicine, ISSN 2469-3103, Vol. 3, nr 1, artikkel-id 028Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess the prevalence of pain, anxiety and depression in a sample of chronic SCI patients in Northern Sweden.

    Design: Descriptive, cross-sectional study.

    Setting: Specialist Clinic at a University Hospital.

    Participants: 78 patients with chronic spinal cord injury, at different injury and functional level.

    Outcome measures: Patients registered presented pain above, at or below injury level on a Visual Analogue Scale (VAS). Patients currently on pain medication were also registered as having pain. Depression and anxiety were assessed by the Hospital Anxiety and Depression Rating Scale (HADS).

    Results: Out of 78 patients, 58 (74%) indicated current presence of pain or were on continuous pain medication. Pain above injury level was present in 32% of the patients, with a mean VAS of 15.9±20.1, range 0-60mm. Pain at injury level were present in 24% of the patients, mean VAS 11.0±17.0, range 0-50mm and 58% had pain below injury level with a mean VAS 31.4±22.3, range 0-80mm.

    Clinically significant psychological disorders were reported in 4 patients (5%) for both anxiety and depression.

    Conclusions: Pain is very common in persons with chronic SCI, but, at least in a drug-treated population, the pain is at a mild or moderate level. Anxiety and depression were found much less common than reported in other studies. Medication effects have been considered. Even in a presumably well-medicated and well-rehabilitated population, there is still a need for further optimization of pain management, including both pharmacological and non-pharmacological methods.

    Keywords: Tetraplegia; Paraplegia; Psychological Disorders; Visual Analogue Scale; Hospital Anxiety and Depression Scale

  • 17.
    Flank, Peter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Wahman, Kerstin
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Fahlström, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Prevalence of risk factors for cardiovascular disease stratified by body mass index categories in patients with wheelchair-dependent paraplegia after spinal cord injury2012Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, nr 5, s. 440-443Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess risk factors for cardiovascular disease at different body mass index values in persons with wheelchair-dependent paraplegia after spinal cord injuries. Design: Cross-sectional study. Subjects: A total of 135 individuals, age range 18-79 years, with chronic (>= 1 year) post-traumatic paraplegia. Methods: Body mass index was stratified into 6 categorical groups. Cardiovascular disease risk factors for hypertension, diabetes mellitus and a serum lipid profile were analysed and reported by body mass index category. Results: More than 80% of the examined participants had at least one cardiovascular disease risk factor irrespective of body mass index level. Hypertension was highly prevalent, especially in men. Dyslipidaemia was common at all body mass index categories in both men and women. Conclusion: Higher body mass index values tended to associate with more hypertension and diabetes mellitus, whereas dyslipidaemia was prevalent across all body mass index categories. Studies that intervene to reduce weight and or percentage body fat should be performed to determine the effect on reducing modifiable cardiovascular disease risk factors.

  • 18. Forslund, E B
    et al.
    Granström, A
    Richard, Levi
    Rehab Station Stockholm R & D Unit, Neurotec Department, Karolinska Institutet, Sweden ; Spinalis SCI Research Unit, Neurotec Department, Karolinska Institutet, Sweden.
    Westgren, N
    Hirschfeld, H
    Transfer from table to wheelchair in men and women with spinal cord injury: coordination of body movement and arm forces2007Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 45, nr 1, s. 41-48Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: A complex set-up was used to investigate kinematics and ground reaction forces.

    SETTING: Motor Control and Physical Therapy Research Laboratory, Neurotec Department, Karolinska Institutet, Huddinge, Sweden.

    OBJECTIVE: To investigate how men and women with spinal cord injury (SCI) perform transfers from table to wheelchair with regard to timing and magnitude of force generation beneath the hands and associated body movements.

    METHODS: A total of 13 subjects (seven men, six women) with thoracic SCI. Kinematics of body movement were recorded (Elite 2000 system) simultaneously with the signals from three force plates (AMTI) placed beneath the buttocks and hands. Temporal and spatial parameters regarding head, trunk and trailing arm displacement, loading amplitudes and loading torque directions of both hands were analyzed for each trial and subject and compared between genders.

    RESULTS: Men and women used similar amplitudes of head bending and forward displacement of the trailing shoulder, while female subjects had significantly larger trunk rotation. Both genders applied significantly more weight on the trailing hand. Differences between genders were seen in direction and timing of peak torque beneath the hands.

    CONCLUSIONS: The forces beneath the trailing hand were larger than those in the leading, if there is weakness or pain in one arm, this arm should be selected as the leading. To avoid excessive load on the arms, technical aids and environmental factors should be very well adapted.

    SPONSORSHIP: This project was funded by the Swedish Research Council and the Health Care Science Committee of Karolinska Institutet.

  • 19. Holtz, Anders
    et al.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Spinal cord injury2010Bok (Annet vitenskapelig)
  • 20. Hultling, C
    et al.
    Richard, Levi
    Amark, S P
    Sjöblom, P
    Semen retrieval and analysis in men with myelomeningocele.2000Inngår i: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 42, nr 10, s. 681-4Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The introduction of advanced assisted reproduction technologies (ART) has created opportunities for the treatment of infertility among patients with myelomeningocele (MMC). The aim of this study was to assess the possibility of semen retrieval and to analyse the semen quality in men with MMC. Nine men, aged 22 to 39 with MMC participated in the study. Two participants were able to achieve unassisted ejaculation. Vibratory stimulation was unsuccessfully attempted in the remaining seven participants who then underwent electroejaculation under general anaesthesia. In total, enough spermatozoa for intracytoplasmic spermatozoa injection were retrieved from five participants. In four cases, no spermatozoa were observed in the ejaculates. Testicular biopsies, however, revealed spermatogenesis, and thus a reproductive potential, in one of these men. Therefore, in six of the nine men with MMC, fatherhood seemed possible with modern ART, despite the semen quality generally being very poor.

  • 21. Hultling, C
    et al.
    Richard, Levi
    Garoff, L
    Nylund, L
    Rosenborg, L
    Sjöblom, P
    Hillensjö, T
    Assisted ejaculation combined with in vitro fertilisation: an effective technique treating male infertility due to spinal cord injury.1994Inngår i: Paraplegia, ISSN 0031-1758, Vol. 32, nr 7, s. 463-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Infertility due to spinal cord injury (SCI) in males has been identified for decades as an area of major concern and techniques for assisted ejaculation are available. There has not been an overall consensus regarding which type of assisted procreation is the most appropriate for these couples. We describe here our experience from a programme based on assisted ejaculation combined with in vitro fertilization (IVF). Twelve couples have been treated so far and altogether 22 cycles with ovum pick-up have been completed. Fertilisation of the oocytes was obtained in 18 of these cycles. The overall oocyte fertilisation rate was 49%. Embryo transfer took place in 17 cycles, leading to seven clinical pregnancies. Four of the pregnancies are delivered or are ongoing, whereas three ended in first trimester spontaneous abortion. Thus our initial experience suggests that assisted ejaculation in combination with IVF is an effective option for these couples.

  • 22. Hultling, C
    et al.
    Rosenlund, B
    Richard, Levi
    Fridström, M
    Sjöblom, P
    Hillensjö, T
    Assisted ejaculation and in-vitro fertilization in the treatment of infertile spinal cord-injured men: the role of intracytoplasmic sperm injection.1997Inngår i: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 12, nr 3, s. 499-502Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The objective of the present longitudinal descriptive study was to extend previous observations on the benefit of in-vitro fertilization (IVF) in cases of anejaculatory infertility due to spinal cord injuries (SCI) and to report results achieved by intracytoplasmic sperm injection (ICSI). The study was performed in a national referral unit for SCI, Spinalis SCI Research Unit, the Karolinska Institute. The patient material consisted of couples with SCI men seeking treatment for their infertility. The inclusion criteria were: stable relationship, motile spermatozoa in a diagnostic sample and no female contraindications. Spermatozoa were retrieved through electroejaculation or vibratory stimulation. If the sperm quality was judged to be sufficient, standard IVF was performed. ICSI was employed if the semen quality was extremely poor. We have treated 25 couples in 52 cycles, leading to 81 ovum retrievals and 47 embryo transfers. Total sperm counts were very variable (0.01-978 x 10(6)). Before the introduction of ICSI the fertilization rate was 30%. ICSI increased the fertilization rate to 88%. There was no association between the pregnancy rate and the sperm count, level of injury or fertilization technique. A total of 16 clinical pregnancies was established, leading to 11 deliveries. This gives a cumulative pregnancy rate per couple of 56%.

  • 23.
    Kerstin, Wahman
    et al.
    Rehab Station Stockholm, Stockholm, Sweden.
    Gabriele, Biguet
    Neurotec Department, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
    Richard, Levi
    Rehab Station Stockholm, Stockholm, Sweden and Neurotec Department, Karolinska Institutet, Stockholm, Sweden.
    What promotes physical activity after spinal cord injury?: An interview study from a patient perspective2006Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, nr 8, s. 481-488Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: Physical activity in people with traumatic spinal cord injury (SCI) is of importance not only for maintaining health but also for increasing the possibilities of living an independent life. Physical inactivity leads to poorer muscular and cardiovascular conditioning and sub-optimal levels of functioning. To help people with SCI to achieve optimum physical activity, it is important to understand what promotes the incorporation of regular physical activity into daily life. The aim of this study was thus to identify factors that may promote participation in physical activity among people with spinal cord injuries.

    METHOD: Qualitative multiple case studies. Sixteen participants with SCI were interviewed.

    RESULT: Four main themes of promoting factors could be identified. They were: using cognitive and behavioural strategies; finding supporting environmental solutions; exploring motivation post injury; and capturing new frames of reference.

    CONCLUSION: By utilising the motivational power of role models, together with the other motivational factors identified in this study, such as identifying relevant individual motives post injury and capturing new frames of reference, the process towards physical active life may be facilitated.

  • 24. Klefbeck, B
    et al.
    Sternhag, M
    Weinberg, J
    Richard, Levi
    Hultling, C
    Borg, J
    Obstructive sleep apneas in relation to severity of cervical spinal cord injury.1998Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 36, nr 9, s. 621-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Thirty-three subjects (28 men, five women) with complete or incomplete cervical cord injury representing a wide range of neurological impairment were investigated with regard to the prevalence of Obstructive Sleep Apnea (OSA). The relation between OSA and neurological function, respiratory capacity, body mass index and symptoms associated with OSA were studied. Overnight sleep recordings employed combined oximetry and respiratory movement monitoring. Pulmonary function tests included static and dynamic spirometry, maximal static inspiratory and expiratory pressures at the mouth. The subjects answered a questionnaire concerning sleep quality and tiredness. The prevalence of OSA was 15% (5/33) in this nonobese cervical cord injury study population. Nine percent of the subjects (3/33) fulfilled the criteria for obstructive sleep apnea syndrome, but daytime sleepiness or fatigue were also common in subjects without OSA. There was an inverse correlation between oxygen desaturation index and American Spinal Injury Association (ASIA) motor score in the subjects with complete injury, while there was no such correlation in the whole study group. There were significant correlations between maximal inspiratory and expiratory pressures and vital capacity and between ASIA motor score and vital capacity.

  • 25.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Att hantera spasticitet: synpunkter ur ett rehabiliteringsperspektiv2011Inngår i: Neurologi i Sverige, ISSN 2000-8538, nr 3, s. 12-17Artikkel i tidsskrift (Annet vitenskapelig)
  • 26.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Hälsa och livsstil kan förbättra vid kronisk neurologisk sjukdom2012Inngår i: Neurologi i Sverige, ISSN 2000-8538, nr 2, s. 63-65Artikkel i tidsskrift (Fagfellevurdert)
  • 27.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Nio tankar om neurologisk rehabilitering2011Inngår i: Neurologi i Sverige, ISSN 2000-8538, nr 1, s. 12-16Artikkel i tidsskrift (Annet vitenskapelig)
  • 28.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Philosophical practice in rehabilitation medicine grasping the potential for personal maturation in existential ruptures2010Inngår i: Philosophical practice, ISSN 1742-8181, Vol. 5, nr 2, s. 607-614Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Rehabilitation medicine, aka Physical medicine and Rehabilitation (PM & R), is the medical specialty which focuses on optimizing function, ability, participation and life satisfaction in the light of noncurable disability and/or chronic disease. It is primarily geared towards the “so what” (i.e. consequences) than towards “what” (i.e. causes). PM & R is holistic and patient-centred, thus comprising a well-suited arena for dialogue and patient participation. Many patients experience a severe crisis reaction in the aftermath of major trauma or disease. This “existential rupture” calls for a fundamental revaluation of many aspects of daily life. Crisis management will not merely be a matter of mourning and then back to “business as usual,” as this often is either not possible or not the optimal choice given altered life circumstances. We propose that philosophical practice (PP) may be an important addition to the rehabilitation process, by facilitating “lifeworld analyses” and thereby making it possible for the patient to find sources of meaning in life despite disability. This “therapy for the sane” (albeit disabled) comprises PP rather than psychiatric or psychotherapeutic interventions, and may come to be seen as a key aspect in the training of future physiatrists and other rehabilitation specialists.

  • 29.
    Levi, Richard
    sektionen för neurorehabilitering, Karolinska institutet; Rehab Station, Stockholm.
    Stora framsteg men ännu ingen "bot"2009Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 11, s. 756-Artikkel i tidsskrift (Fagfellevurdert)
  • 30.
    Levi, Richard
    et al.
    sektionen för neurorehabilitering, Karolinska institutet, Stockholm.
    Ahuja, Sanjay
    Rehab Station, Stockholm.
    Neurologiska följdtillstånd och komplikationer2009Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 11, s. 768-771Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [sv]

    Neurologiska bortfallssymtom efter en traumatisk ryggmärgsskada är i regel stationära i det kroniska skedet. Vid tillkommande neurologiska symtom görs en etiologisk undersökning och bakomliggande posttraumatisk myelopati eller annan behandlingsbar orsak utesluts eller åtgärdas. Den primära utredningen innefattar magnetkameraundersökning av hela ryggen.

  • 31.
    Levi, Richard
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Hultling, Claes
    Karolinska Institutet.
    Spinalishandboken: ny kraft för skadad ryggmärg2011Bok (Annet (populærvitenskap, debatt, mm))
  • 32.
    Nilsson, Stefan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Nordström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Idrottsmedicin.
    Treatment-resistant sensory motor symptoms in persons with SCI may be signs of restless legs syndrome2011Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 49, nr 6, s. 754-756Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study design: Case report on the successful treatment with pramipexole in four men with chronic spinal cord injury (SCI) suffering from refractory symptoms that were previously considered to be manifestations of a post-traumatic spastic syndrome or neuropathic pain.

    Objective: To raise awareness among health professionals regarding the diagnostic and therapeutic possibility of restless legs syndrome (RLS) and periodic limb movements (PLMs) in some patients with SCI responding poorly to conventional treatment for spasticity or neuropathic pain.

    Setting: Neurorehabilitation department of the Rehabilitation Medicine Center of Northern University Hospital, Umeå, Sweden.

    Methods: Medical records and clinical data were retrospectively reviewed.

    Results: All cases obtained treatment with pramipexole, initially 0.09–0.72 mg day−1. Two of the cases had RLS and PLMs, one RLS only and one PLMs only. All four reported symptoms in the lower extremities and one also in the upper extremities. Three patients with residual gait function reported RLS score with/without treatment as follows: 32/11, 37/12 and 33/12. One patient with complete paraplegia (with incomplete RLS score) reported 22/10. After a follow-up period of 16, 20, 43 and 49 months, respectively, all four still reported excellent outcomes. Two remained on initial dosage; one had increased dosage from 0.09 to 0.18 mg day−1 and one from 0.27 to 0.80 mg day−1 during the follow-up period.

    Conclusions: In persons with SCI suffering from infralesional involuntary movements and/or dysesthesia and with poor response to conventional antispastic or analgesic treatment, the possibility of RLS or PLMs should be considered, as these conditions seem eminently treatable.

  • 33.
    Nordgren, Camilla
    et al.
    Neurotec Department, Karolinska Institutet, Stockholm, Sweden and Spinalis SCI Research Unit, Karolinska Institutet, Stockholm, Sweden.
    Richard, Levi
    Neurotec Department, Karolinska Institutet, Stockholm, Sweden and Spinalis SCI Research Unit, Karolinska Institutet, Stockholm, Sweden and Frösunda Center Research Unit, Karolinska Institutet, Stockholm, Sweden.
    Ljunggren, Gunnar
    Neurotec Department, Karolinska Institutet, Stockholm, Sweden.
    Seiger, Åke
    Neurotec Department, Karolinska Institutet, Stockholm, Sweden and Spinalis SCI Research Unit, Karolinska Institutet, Stockholm, Sweden and Frösunda Center Research Unit, Karolinska Institutet, Stockholm, Sweden.
    Societal services after traumatic spinal cord injury in Sweden2003Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, nr 3, s. 121-126Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Societal services after traumatic spinal cord injury in Sweden were investigated, including self-rated levels of satisfaction with the application process and resource allocation.

    DESIGN: Survey of an incidence population.

    SUBJECTS: Thirty-four persons of a total regional incidence population (n = 48) with traumatic spinal cord injury.

    METHODS: Structured interviews using a standardized questionnaire.

    RESULTS: About 25 separate services were identified being available for persons with traumatic spinal cord injury. The average number of applications per person was 5 (range 0-11). The most common service was "transportation service". Of the applications, 17% were partially or totally rejected. Most subjects received information about available services from a social worker. For 13 available services at least 1 subject claimed ignorance about its existence.

    CONCLUSIONS: In Sweden, significant resources are allocated for allowing independence and financial compensation for individuals with traumatic spinal cord injury. However, this support system sometimes also results in frustration and disappointment. Insufficient information and co-ordination are reported as weaknesses. The persons' efforts to acquire knowledge of how the system works take time which could be better used for rehabilitation and full integration into the community.

  • 34. Norrbrink Budh, C
    et al.
    Lund, I
    Hultling, C
    Richard, Levi
    Werhagen, L
    Ertzgaard, P
    Lundeberg, T
    Gender related differences in pain in spinal cord injured individuals.2003Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 41, nr 2, s. 122-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: Out of a population of 456 patients with spinal cord injuries (SCI), 130 having pain were selected after matching, based on gender, age, American Spinal Injury Association (ASIA) impairment grade and level of lesion.

    OBJECTIVE: To investigate whether gender differences with regard to pain perception and prevalence exist in a population of patients following spinal cord injury.

    SETTING: Spinalis SCI Unit (out-patient clinic), Stockholm, Sweden.

    METHOD: 130 patients suffering from pain were assessed over a 12-month period in a yearly health control.

    RESULTS: SCI women had a higher prevalence of nociceptive pain than men and their use of analgesics was greater. However, no differences between the sexes could be seen regarding pain and localization, onset, distribution, factors affecting pain, number of painful body regions, pain descriptors, ratings of pain intensities or in pain and life satisfaction.

    CONCLUSION: This study showed that SCI men and women describe their pain very similarly. However, SCI women had a higher prevalence of nociceptive pain than men and their use of opiates and non-steroid anti-inflammatory drugs (NSAIDs) was greater.

  • 35.
    Norrbrink Budh, Cecilia
    et al.
    Karolinska Institutet, Stockholm.
    Lund, Iréne
    Karolinska Institutet, Stockholm.
    Ertzgaard, Per
    Department of Rehabilitation Medicine, Faculty of Health Sciences, Linköping.
    Holtz, Anders
    Department of Neurosurgery, University Hospital, Uppsala.
    Hultling, Claes
    Karolinska Institutet, Stockholm.
    Richard, Levi
    Karolinska Institutet, Stockholm.
    Werhagen, Lars
    Spinalis SCI unit Karolinska Hospital, Stockholm.
    Lundeberg, Thomas
    Karolinska Institutet, Stockholm.
    Pain in a Swedish spinal cord injury population2003Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 17, nr 6, s. 685-690Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To describe pain and associated variables in a prevalence group of persons with a sustained spinal cord injury (SCI) in the Swedish capital and its surroundings.

    SETTING: Spinalis SCI Unit (outpatient clinic), Stockholm, Sweden.

    DESIGN: Assessment over a 12-month period in a yearly health control.

    SUBJECTS: Four hundred and fifty-six SCI patients.

    RESULTS: Two hundred and ninety-one out of 456 SCI patients (63.7%) suffered from pain, and in 45.7% of these it was classified as being neurogenic. Aching pain was the most used descriptor (38.5%). The onset of pain was commonly within three months (73.5%). In 70.4% of patients pain occurred below the level of the lesion. Most patients identified pain as coming from one (55.0%) or two (28.2%) body regions. Rating of the general pain intensity on a visual analogue scale (VAS) was 46 out of 100 and rating of the worst pain intensity was 78 out of 100. Ninety-four out of 276 patients (32.3%) considered that their quality of life was significantly affected by pain.

    CONCLUSION: Pain was most common in patients with incomplete lesions (ASIA impairment grade D) and there was a correlation between pain and higher mean age at injury and between pain and female gender.

  • 36. Osteråker, A-L
    et al.
    Richard, Levi
    Indicators of psychological distress in postacute spinal cord injured individuals.2005Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 43, nr 4, s. 223-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN: Consecutive inclusion of spinal cord injured patients admitted for postacute rehabilitation from June 2000 to January 2002.

    OBJECTIVE: Assessment of prevalence of indicators of psychological distress in the subacute and early chronic stages after acute-onset spinal cord injury (SCI).

    SETTING: A Swedish rehabilitation center.

    METHODS: In all, 36 patients participated. Psychological assessment was obtained at admission, discharge and 6 months follow-up by psychological measures based on the DSM-IV (ie Beck's Depression Inventory, SPIFA, SCID-screen, AUDIT) and clinical interview. Ongoing psychotropic medication was noted.

    RESULTS: Clinical depression was infrequent. However, ongoing psychotropic medication was common, possibly indicating a relatively high incidence of underlying depressive and anxiety disorders. In all, 25% of the sample showed indicators of high alcohol consumption. Few patients had a previously diagnosed personality disorder. By contrast, there was frequent occurrence of personality traits outside normal ranges.

    CONCLUSION: Medication of psychological problems commonly occurs after SCI, especially for depression and anxiety. There are indications of alcohol overconsumption in a substantial minority of SCI patients. The study raises the question of whether suppression of psychological symptoms by drug therapy is the optimal treatment of such problems in a rehabilitation process.

  • 37. Richard, Levi
    et al.
    Edman, G V
    Ekbom, K
    Waldenlind, E
    Episodic cluster headache. I: Personality and some neuropsychological characteristics in male patients.1992Inngår i: Headache, ISSN 0017-8748, E-ISSN 1526-4610, Vol. 32, nr 3, s. 119-25Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The etiology and pathogenesis of cluster headache remain largely unknown. Some previous studies have focused on personality characteristics in cluster headache. However, no consistent personality profile has been found. The present study applied two personality inventories, the Karolinska Scales of Personality (KSP) and the Heart and Lifestyle Type A Measure (HALTAM), that have not previously been used in the context of cluster headache. A correlation has been suggested between left-handedness and early learning difficulties, and cluster headache. Thus, these variables were included and measured by inventory techniques. Forty-nine out of 51 consecutive male patients with episodic cluster headache participated in the present study. As compared to controls, the cluster headache patients were significantly more anxiety-prone (higher scores in the KSP Somatic anxiety and Muscular tension subscales), less successfully socialized (low scores in the KSP Socialization scale), and had a more hostile attitude towards others (higher scores in the HALTAM Hostility scale). No relationships between left-handedness or early learning difficulties, and cluster headache disease were found. The implications of the personality differences for the etiology of cluster headache disease are discussed.

  • 38. Richard, Levi
    et al.
    Edman, G V
    Ekbom, K
    Waldenlind, E
    Episodic cluster headache. II: High tobacco and alcohol consumption in males.1992Inngår i: Headache, ISSN 0017-8748, E-ISSN 1526-4610, Vol. 32, nr 4, s. 184-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Forty-nine out of 51 consecutive male patients with episodic cluster headache were studied with regard to their smoking and drinking habits in general and in relation to cluster headache periods. Questionnaires were constructed for data regarding tobacco intake. Situation-related smoking behavior was registered according to Frith (1971). Screening for alcohol over-consumption was made using the Malmö modification of the brief Michigan Alcoholism Screening Test (Mm-MAST). Eighty-three percent of the patients used tobacco on a regular basis at the time of the study, with an average consumption of 20 cigarettes per day. Only 3% had never used tobacco regularly. The smoking-related desire to smoke in different situations was consistent with what is found in a general population of smokers. Sixty-seven percent of the patients had scores on the Mm-MAST indicative of alcohol over-consumption (i.e. heavy social drinking or alcoholism). During active headache periods 79% decreased their alcohol intake, whereas no consistent change in tobacco consumption was reported for the group as a whole. These findings were further corroborated by the fact that alcohol, but not tobacco intake, was reported by the majority of patients to elicit headache attacks during periods. Thus, our study showed high alcohol and tobacco consumption to be prominent features in male patients with episodic cluster headache. Since neither alcohol nor tobacco appear to have properties of ameliorating headache periods or attacks, the addictive behavior in our patients more likely reflects certain personality characteristics.

  • 39. Richard, Levi
    et al.
    Ertzgaard, P
    Quality indicators in spinal cord injury care: a Swedish collaborative project. The Swedish Spinal Cord Injury Council 1998.1998Inngår i: Scandinavian journal of rehabilitation medicine. Supplement, ISSN 0346-8720, Vol. 38, s. 1-80Artikkel i tidsskrift (Fagfellevurdert)
  • 40. Richard, Levi
    et al.
    Hultling, C
    Nash, M S
    Seiger, A
    The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population.1995Inngår i: Paraplegia, ISSN 0031-1758, Vol. 33, nr 6, s. 308-15Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Out of a regional traumatic spinal cord injury population consisting of 379 individuals, 353 (93.1%) participated in the present study. Subjects were individually interviewed using semi-structured protocols. In addition, previous medical records were available for over 96% of subjects, and were used in all these cases to minimise recall bias. Cause of injury, prevalence of present medical symptoms and occurrence of medical complications in the post-acute, post-discharge phase were recorded. Neurological classification was verified by physical examination according to ASIA/IMSOP standards. Many subjects had experienced complications since discharge from initial hospitalisation, especially urinary tract infections, decubitus ulcers, urolithiasis, and neurological deterioration. Prevalence of medical symptoms was also high. More than 41% of subjects with spastic paralysis reported excessive spasticity to be associated with additional functional impairment and/or pain. Almost two-thirds of subjects reported significant pain, with a predominance of neurogenic-type pain. Bladder and bowel dysfunction were each rated by nearly 41% of subjects as a moderate to severe life problem. As expected, sexual dysfunction was also commonly reported. Prevalence of reported symptoms by general systems review was high, particularly fatigue, constipation, ankle oedema, joint and muscle problems, and disturbed sleep. However, lack of adequate normative data precludes comparison with the general population. The frequent occurrence of reported medical problems and complications support advocacy of comprehensive, life-long care for SCI patients. The commonly reported problems of neurogenic pain and neurological deterioration, in particular, require more attention, as these symptoms are not seldom ominous, either by virtue of their impact on quality of life, or because of underlying pathology.

  • 41. Richard, Levi
    et al.
    Hultling, C
    Seiger, A
    The Stockholm Spinal Cord Injury Study: 2. Associations between clinical patient characteristics and post-acute medical problems.1995Inngår i: Paraplegia, ISSN 0031-1758, Vol. 33, nr 10, s. 585-94Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The Stockholm Spinal Cord Injury Study (SSCIS) is an extensive evaluation of a sample of 353 subjects with traumatic SCI, constituting 93% of the known regional prevalence population with this diagnosis. In a previous analysis of this group, symptoms such as pain, incontinence, sexual dysfunction and neurological deterioration, as well as secondary complications, such as decubitus ulcers, urinary tract infections, spinal deformity and fractures, were found to be common. In the present report, we investigate associations between a few commonly used patient characteristics, ie gender, age at injury, duration of injury and extent of neurological compromise, and the occurrence of such problems, to assess differences in vulnerability in SCI subgroups. Results generally indicate an increased vulnerability in subjects with extensive neurological deficits, as well as a cumulation of complications with the increasing duration of injury. However, some exceptions are found, possibly indicating differences in temporal patterns of the occurrence of various complications, as well as certain gender-, age-, and lesion-associated variations in vulnerability. Symptoms directly related to the spinal cord lesion, eg neurogenic pain and neurological deterioration, seem to present rather soon post-injury. Males are more prone to experience excessive spasticity and sexual problems. Females experience more fractures and spinal deformity. Younger age at injury is associated with more spinal deformity but less severe pain problems. Higher age at injury is not found to be associated with more medical problems, with the exception of neurogenic pain, among post-acute, post-discharge survivors. The latter finding does not, however, preclude more such problems in the acute stage, since the present study neither addresses the pre-discharge period, nor includes information about mortality. Finally, the ASIA/IMSOP Impairment Scale Grade E-rated subjects were found to report problems to an extent that underlines the restricted sensorimotor sense in which this rating reflects recovery.

  • 42. Richard, Levi
    et al.
    Hultling, C
    Seiger, A
    The Stockholm Spinal Cord Injury Study. 3. Health-related issues of the Swedish annual level-of-living survey in SCI subjects and controls.1995Inngår i: Paraplegia, ISSN 0031-1758, Vol. 33, nr 12, s. 726-30Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In previous articles on the Stockholm Spinal Cord Injury Study (SSCIS), we have reported the frequent occurrence of medical problems in a near-total regional SCI population comprising 353 subject. This present study further investigates health-related issues in this SCI population, by a level-of-living survey that has been used annually on 8000-14,000 Swedes since 1974. The health-focused version of this survey was used for data collection in those 326 subjects in the SSCIS who were residents of the Greater Stockholm area. Subjects of the SSCIS living on the island of Gotland were excluded because they represented a sociodemographically different (rural) population. The normative material consisted of 1978 interviews of residents of the Greater Stockholm area, provided by the Swedish Bureau of Statistics. Results show a higher utilisation of health care resources among SCI subjects, shown by higher rates of long-term sick leave and sick pension, and more treatment as inpatients, emergency room attendees, and outpatients. Pain, bladder problems, and psychological symptoms are more commonly reported by SCI subjects. Medications such as antibiotics, analgesics, sedatives, hypnotics and laxatives are used more frequently in the SCI group. In contrast, no statistically significant differences were found as regards reported prevalence of diseases other than SCI, including diabetes, hypertension and cardiac disease. The results thus verify the impression from our previous studies of a clearly increased morbidity among these SCI subjects. The increased morbidity seems to be accounted for by the SCI itself, or conditions directly caused by it.

  • 43. Richard, Levi
    et al.
    Hultling, C
    Seiger, A
    The Stockholm spinal cord injury study: 4. Psychosocial and financial issues of the Swedish annual level-of-living survey in SCI subjects and controls.1996Inngår i: Paraplegia, ISSN 0031-1758, Vol. 34, nr 3, s. 152-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    In a series of articles from the Stockholm Spinal Cord Injury Study (SSCIS), the health status of a near-total regional SCI population comprising 353 subjects has been investigated. The present study describes the psycho-social and financial consequences of SCI in this group. It is based on a level-of-living survey that has been used annually on 8000-14,000 Swedes since 1974. The health-focused version of this survey was used for data collection in the subset of 326 subjects in the SSCIS that were residents of the Greater Stockholm area. The normative material consisted of 1978 interviews of residents of the same area, provided by the Swedish Bureau of Statistics. The results show that SCI subjects, although provided with basic material commodities up to par with the general population, have less financial reserves and more frequently express worry about their finances. Less than half of the subjects are gainfully employed, when part-time jobs are also included. Social activities are more restricted, and more centered on the core social network. Several items in the survey point to a preoccupation with personal rather than public matters. We feel that these factors, at least to some degree, are consequential to separation from the workplace, with resulting disadvantageous financial and social effects. Intensified vocational rehabilitation efforts might thus be justified from both an economic and a psycho-social point of view.

  • 44. Richard, Levi
    et al.
    Hultling, C
    Westgren, N
    A computer assisted follow up system for spinal cord injury patients.1994Inngår i: Paraplegia, ISSN 0031-1758, Vol. 32, nr 11, s. 736-42Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The comprehensive care of patients with traumatic spinal cord injuries (SCI) necessitates, among other things, a structured, life-long follow up. The high consumption of medical care in chronic SCI patients, often a result of diseases affecting many different organ systems, soon causes the cumulated medical documentation to be extensive and therefore hard to survey. The possibilities for rational patient management, adequate quality assurance, and clinical research may improve considerably by computerisation of medical records. A computerised medical records system for SCI has recently been developed, using a semistructured medical record format for data input and a medical entity dictionary for facilitated data storage and retrieval. The principles for developing this computer-assisted follow up system are described.

  • 45. Sköld, C
    et al.
    Harms-Ringdahl, K
    Hultling, C
    Richard, Levi
    Seiger, A
    Simultaneous Ashworth measurements and electromyographic recordings in tetraplegic patients.1998Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 79, nr 8, s. 959-65Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: A recent prevalence study of 353 spinal cord injured (SCI) individuals in the greater Stockholm area showed problematic spasticity in 30% of this population. To treat spasticity, the evaluation becomes crucial. The modified Ashworth scale (MAS) is the clinically most-used scale to grade degree of spasticity. This study evaluated whether the MAS correlated with electromyographic (EMG) recordings of muscle activity.

    STUDY DESIGN: This cross-sectional study was performed at an outpatient clinic that has the responsibility to do a standardized, yearly follow-up of all SCI patients in the greater Stockholm area. Thirty-eight SCI individuals met the inclusion criteria; 15 of the 38 were randomly selected for the study. They were all motor-complete tetraplegic men; mean age was 33 years and mean time since injury was 9 years. Spasticity evaluation was performed by flexing and extending the knees during simultaneous EMG recordings and MAS assessment of the thigh muscle activity.

    RESULTS: Eighty percent of the individual EMG recordings correlated significantly with the corresponding Ashworth measurements. The spastic resistance, as measured both clinically and electromyographically, was stronger and lasted longer during extension than flexion movements. Spearman coefficients for correlation of quantitative spasticity measures with MAS grades were calculated. EMG and clinical measures of spasticity were more closely correlated for flexion movements. Among EMG parameters, duration of movement-associated electrical activity invariably correlated significantly with the MAS grades (p < .05). Furthermore, Ashworth measurements of movement-associated spasticity showed a positive correlation with the EMG parameters mean, peak, and start to peak of electrical activity. Each increasing grade on the MAS corresponded to increasing myoelectric activity levels for each movement.

    CONCLUSION: EMG parameters were significantly positively correlated with simultaneous MAS measurements of the spastic muscle contraction. The Ashworth scale may therefore accurately reflect the movement-provoked spasticity in motor-complete tetraplegic patients.

  • 46. Sköld, C
    et al.
    Richard, Levi
    Seiger, A
    Spasticity after traumatic spinal cord injury: nature, severity, and location.1999Inngår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 80, nr 12, s. 1548-57Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To assess spasticity in a prevalence population of persons with traumatic spinal cord injury (SCI), and determine the degree of correspondence between self-reported spasticity and investigator-elicited spasticity using the modified Ashworth scale.

    DESIGN: Survey of a near total (88%) prevalence population.

    SETTING: Outpatient clinic of a university hospital.

    PATIENTS: A total of 354 individuals with SCI.

    MAIN OUTCOME MEASURES: The survey includes self-reported symptoms, neurologic examination (American Spinal Injury Association [ASIA] classification), physical therapy examination, range of motion (ROM), and complications.

    RESULTS: Presence of problematic spasticity was significantly correlated with cervical incomplete (ASIA B-D) injury. Reports of beneficial effects of spasticity were significantly less common in women. Self-reported problematic spasticity was significantly correlated with extensor spasticity. Spasticity was elicitable by movement provocation in 60% of the patients reporting spasticity. Significant correlations were found between elicitable spasticity and limited ROM.

    CONCLUSION: Flexion, extension, and abduction movements performed with the patient placed in a standardized supine test position are suitable both for test of ROM and degree of spasticity. Spasticity was not elicitable by movement provocation on physical examination in 40% of the patients who reported spasticity, thus indicating that the patient's self-report is an important complement to the clinical assessment. A significant association between spasticity and contractures (reduced ROM) was seen.

  • 47.
    Sköld, Camilla
    et al.
    Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Stockholm, Sweden, and Spinalis SCI Research Unit, Karolinska Institute, Stockholm.
    Lönn, Lars
    Department of Radiology, Body Composition and Metabolism, Sahlgrenska University Hospital, Göteborg, Sweden.
    Harms-Ringdahl, Karin
    Department of Physical Therapy, Karolinska Institute and Karolinska and Huddinge University Hospitals, Stockholm, Sweden.
    Hultling, Claes
    Spinalis SCI Research Unit, Karolinska Institute, Stockholm, Sweden.
    Richard, Levi
    Spinalis SCI Research Unit, Karolinska Institute, Stockholm, Sweden.
    Nash, Mark
    Department of Orthopedics and Rehabilitation and the Miami Project to Cure Paralysis, University of Miami School of Medicine, Miami, florida, USA.
    Seiger, Åke
    Spinalis SCI Research Unit, Karolinska Institute, Stockholm, Sweden.
    Effects of functional electrical stimulation training for six months on body composition and spasticity in motor complete tetraplegic spinal cord-injured individuals2002Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 34, nr 1, s. 25-32Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The effect of functional electrical stimulation (FES) training on body composition, assessed by computed tomography, and the effect of spasticity, assessed by both objective and subjective measures, are evaluated. Fifteen motor-complete spinal-cord-injured men participated in the study. Eight of the 15 subjects undertook FES cycling 3 times weekly for 6 months. Whole body computed tomography scans evaluated changes in body composition. Simultaneous Modified Ashworth Scale and electromyography (EMG) measurements, resistive torque (Kin-Com) and EMG measurements, and self-ratings with Visual Analogue Scale during four consecutive days were used to evaluate changes in spasticity. Lower extremity muscle volume increased by an average of 1300 cm3 (p < 0.001) in the training group compared to the control group, who experienced no change. Otherwise no changes in body composition were seen. Significant correlations (Spearman) were found between individual EMG activity recordings and movement-provoked Modified Ashworth Scale ratings in 26% of the test situations, irrespective of group and time. The objective and subjective evaluation of movement-provoked passive (viscoelastic) and active (spasticity-related) resistance remained unchanged.

  • 48.
    Stenberg, Gunilla
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Fysioterapi.
    Henje, Catharina
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Designhögskolan vid Umeå universitet.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Lindström, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Arbetsterapi.
    Living with an electric wheelchair: the user perspective2016Inngår i: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 11, nr 5, s. 385-394Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To explore the experiences of using an electric wheelchair in daily living. Methods: Fifteen participants, eight women and seven men, living in different parts of a Nordic country were interviewed. The interviews were conducted in the home or at the workplace. Open-ended questions were used. The data were collected and analyzed according to the grounded theory. Results: Analysis resulted in one core category: "Integrating the electric wheelchair - a manifold process", describing a process commencing from initial resistance against use of an electric wheelchair, to acceptance with various extent of integration. Six categories emerged that represent this core process: incorporating the electric wheelchair into the self-identity process, calculating functional consequences, encountering the reactions of others, facing duality in movability, using proactive strategies, and being at the mercy of the system. Findings indicate that the integration process is complex and manifold. Practical, personal, and social dimensions were intertwined and significantly involved. Conclusions: Integrating an electric wheelchair is a process closely connected to symbolic value, usability, community mobility and identity. These aspects should be considered in the production, prescription, and adaptation processes. Implications for Rehabilitation Integrating an electric wheelchair is a process closely connected to symbolic value, usability, community mobility, and identity. These aspects should be considered in the wheelchair production, prescription, and adaptation processes.

  • 49.
    Stenberg, Maud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Godbolt, Alison K.
    Nygren De Boussard, Catharina
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Cognitive impairment after severe traumatic brain injury, clinical course and impact on outcome: a Swedish-Icelandic study2015Inngår i: Behavioural Neurology, ISSN 0953-4180, E-ISSN 1875-8584, artikkel-id 680308Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective. To assess the clinical course of cognitive and emotional impairments in patients with severe TBI (sTBI) from 3 weeks to 1 year after trauma and to study associations with outcomes at 1 year.

    Methods. Prospective, multicenter, observational study of sTBI in Sweden and Iceland. Patients aged 18-65 years with acute Glasgow Coma Scale 3-8 were assessed with the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and the Hospital Anxiety and Depression Scale (HADS). Outcome measures were Glasgow Outcome Scale Extended (GOSE) and Rancho Los Amigos Cognitive Scale-Revised (RLAS-R).

    Results. Cognition was assessed with the BNIS assessed for 42 patients out of 100 at 3 weeks, 75 patients at 3 months, and 78 patients at 1 year. Cognition improved over time, especially from 3 weeks to 3 months. The BNIS subscales "orientation" and "visuospatial and visual problem solving" were associated with the GOSE and RLAS-R at 1 year.

    Conclusion. Cognition seemed to improve over time after sTBI and appeared to be rather stable from 3 months to 1 year. Since cognitive function was associated with outcomes, these results indicate that early screening of cognitive function could be of importance for rehabilitation planning in a clinical setting.

  • 50.
    Stenberg, Maud
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Koskinen, Lars-Owe D
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Severe traumatic brain injuries in Northern Sweden: a prospective 2-year study2013Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, nr 8, s. 792-800Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To assess: (i) the clinical characteristics and injury descriptors of patients with severe traumatic brain injury in Northern Sweden admitted to the single Neurotrauma Center (NC) serving this region; (ii) the care pathway of patients from injury to 3 months after discharge from the NC; and (iii) the outcomes at 3 months post-injury. Population-based prospective 2-year cohort study.Patients age 17–65 years with acute severe traumatic brain injury, lowest non-sedated Glasgow Coma Scale (GCS) score of 3–8 within 24 h post-trauma. Patients were treated according to an intracranial pressure-oriented protocol based on the Lund concept at the NC. They were assessed at 3 weeks after injury with Rancho Los Amigos Cognitive Scale Revised (RLAS-R), Levels of Cognitive functioning, and at 3 months with RLAS-R and Glasgow Outcome Scale Extended (GOSE).A total of 37 patients were included. Hospital deaths within 3 months post-injury occurred in 5 patients. After 3 months the RLAS-R scores were significantly improved (< 0.001). Eight patients had both “superior cognitive functioning” on the RLAS-R and “favourable outcome” on the GOSE. Thirty-four patients (92%) were directly admitted to the NC. By contrast, after discharge patients were transferred back to one of several county hospitals or to one of several local hospitals, and some had multiple transfers between different hospitals and departments. Overall outcomes were surprisingly good in this group of severely injured patients. The routines for transferring patients with severe traumatic brain injury from a geographically large, sparsely populated region to a regional NC to receive well-monitored neurosurgical care seem to work very well. The post-acute clinical pathways are less clearly reflecting an optimized medical and rehabilitative strategy.

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