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  • 1. Akinwuntan, Abiodun
    et al.
    Hu, Xiao-Lei
    Terrill, lexandra L.
    Perea Burns, Suzanne
    Cooper Hay, Catherine
    Belagaje, Samir R.
    Young Stroke: Resources for Patients, Their Families, and Caregivers for Long-Term Community Living2021Ingår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 102, nr 5, s. 1035-1039Artikel i tidskrift (Refereegranskat)
  • 2.
    Andersson, Jenni
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Magaard, Gustaf
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Long-term perceived disabilities up to 10 years after transient ischaemic attack2021Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 53, nr 3, artikel-id jrm00167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The long-term impact of transient ischaemic attack is largely unknown.

    OBJECTIVES: To assess the long-term perceived impact of transient ischaemic attack and explore the influence of sex and age on these perceptions; and to evaluate the relationships between activities of daily living, participation and overall recovery, and the other domains of the Stroke Impact Scale 3.0 (SIS).

    METHODS: A retrospective study among adult community-dwelling individuals from 6 months up to 10 years after onset of transient ischaemic attack. A total of 299 survivors of transient ischaemic attack responded to the SIS.

    RESULTS: Most self-reported disabilities involved emotion, strength, and participation domains of SIS and remained stable until 10 years post-transient ischaemic attack. Women reported significantly more disabilities for emotion and hand function. Elderly subjects (age > 65 years) reported more disabilities for strength, mobility, hand function, activities of daily living/instrumental activities of daily living, and participation. The activities of daily living/instrumental activities of daily living, participation, and overall recovery demonstrated significant, although low-to-moderate, associations with other SIS domains after transient ischaemic attack.

    CONCLUSION: The broadly perceived disabilities were demonstrated consistently and played a significant meaningful role in everyday life and recovery among community-dwelling individuals up to 10 years after a transient ischaemic attack. These findings indicate the need for long-term multi-professional follow-up with holistic rehabilitation to improve overall recovery among survivors of transient ischaemic attack.

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  • 3. Borg, Kristian
    et al.
    Brodda Jansen, Gunilla
    Gripenstedt, Ulla-Britt
    Hill, Mattias
    Lindgren, Marie
    Westergren, Hans
    Hu, Xiao-Lei
    Rehabiliteringsmedicinska kliniken, Norrlands universitetssjukhus, Umeå.
    Ackermark, Pernilla
    Andersen, Christian
    Antepohl, Wolfram
    Deboussard, Catharina
    Ersson, Anders
    Häglund, Vera
    Lexell, Jan
    Pessah-Rasmussen, Hélène
    Rivano Fischer, Marcelo
    Rudling, Karin
    Stibrant-Sunnerhagen, Katharina
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Behovet av rehabilitering måste mötas efter svår covid-192020Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, nr 19-20Artikel i tidskrift (Refereegranskat)
  • 4.
    Burns, Suzanne Perea
    et al.
    Division of Occupational Therapy, University of New Mexico School of Medicine, Albuquerque, NM, USA.
    Fleming, Talya K.
    JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, NJ, USA.
    Webb, Sam S.
    Department of Experimental Psychology, University of Oxford, Oxford, UK.
    Kam, Alice Sau Han
    Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada; Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada.
    Fielder, Jaimee D.P.
    Pate Rehabilitation, Fort Worth, TX, USA.
    Kim, Grace J.
    Department of Occupational Therapy, New York University, New York City, NY, USA; Department of Rehabilitation Medicine, NYU Langone Health, New York City, NY, USA.
    Hu, Xiaolei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Hill, Mary Thelander
    Division of Occupational Therapy, University of New Mexico School of Medicine, Albuquerque, NM, USA.
    Kringle, Emily A.
    Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
    Stroke Recovery During the COVID-19 Pandemic: A Position Paper on Recommendations for Rehabilitation2022Ingår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 103, nr 9, s. 1874-1882Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Health care delivery shifted and adapted with the COVID-19 pandemic caused by the novel severe acute respiratory syndrome coronavirus 2. Stroke care was negatively affected across the care continuum and may lead to poor community living outcomes in those who survived a stroke during the ongoing pandemic. For instance, delays in seeking care, changes in length of stays, and shifts in discharge patterns were observed during the pandemic. Those seeking care were younger and had more severe neurologic effects from stroke. Increased strain was placed on caregivers and public health efforts, and community-wide lockdowns, albeit necessary to reduce the spread of COVID-19, had detrimental effects on treatment and recommendations to support community living outcomes. The American Congress of Rehabilitation Medicine Stroke Interdisciplinary Special Interest Group Health and Wellness Task Force convened to (1) discuss international experiences in stroke care and rehabilitation and (2) review recently published literature on stroke care and outcomes during the pandemic. Based on the findings in the literature, the task force proposes recommendations and interdisciplinary approaches at the (1) institutional and societal level; (2) health care delivery level; and (3) individual and interpersonal level spanning across the care continuum and into the community.

  • 5.
    Devos, Hannes
    et al.
    University of Kansas Medical Center, Kansas City, KS, USA.
    Ng, Christi
    Children's Hospital Colorado, Aurora, CO, USA.
    Santos, Flavia H.
    University College Dublin, Dublin, Ireland.
    Sood, Pallavi
    Malmö University, Malmö, Sweden.
    Hu, Xiao-Lei
    Malmö University, Malmö, Sweden.
    Zanwar, Preeti
    Thomas Jefferson University, Philadelphia, PA, USA.
    Ogawa, Elisa
    VA Boston Healthcare System, Boston, MA, USA.
    Heyn, Patricia
    Marymount University, Arlington, VA, USA.
    Virtual reality for cognitive rehabilitation: a beginner’s guide for clinicians2023Ingår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, Vol. 104, nr 2, s. 355-358Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Despite the promising benefits of virtual reality (VR) cognitive rehabilitation and the affordable VR systems currently on the market, few VR tools have found their way into the clinic. The purpose of this Information and Education page is to assist clinicians in deciding which VR systems are useful for cognitive rehabilitation.

  • 6.
    Elgh, Eva
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Hu, Xiaolei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Dynamic Trajectory of Long-Term Cognitive Improvement Up to 10 Years in Young Community-Dwelling Stroke Survivors: A Cohort Study2019Ingår i: Frontiers in Neurology, E-ISSN 1664-2295, Vol. 10, artikel-id 97Artikel i tidskrift (Refereegranskat)
    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.

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  • 7.
    Elgh, Eva
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Premorbid employment and education predicts improvement in general cognition ten years after stroke onset: a longitudinal cohort study2023Ingår i: Journal of Neuroscience and Neurological Surgery, ISSN 2578-8868, Vol. 13, nr 1, artikel-id 260Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: We have recently demonstrated significant general cognitive recovery with delayed improvement of working memory 10 years after stroke in a unique longitudinal cohort.Aim: This study investigated demographic and clinical characteristics relevant to improved cognitive functions 10-year after a first-ever stroke.   

    Materials and Methods: A prospective longitudinal cohort study was carried out in 38 middle-aged (mean age =54 at stroke onset) stroke survivors. Cognition was assessed thrice at one week, seven months, and ten years after the stroke. Working memory and visuospatial function were assessed with the Digit Span and Block Design subtests, respectively. General cognition was evaluated with the Mini-Mental State Examination at the two later time points. Multivariate linear regression was used to identify the variables that may significantly predict improved cognitive functions at 10-year follow-up.

    Results: We found that having a full-time job prior to the stroke, suffering an ischemic (as opposed to a hemorrhagic) stroke, and having a university education predicted significantly superior general cognitive function 10 years after stroke (R2 of 0.77, p <0.001), while working memory and visuospatial function at 1 week after stroke significantly predicted their respective functions at 10-year follow-up (R2 of 0.41, p = 0.003). 

    Conclusions: Our results indicate that premorbid employment status and higher education as well as having suffered from an ischemic rather than a hemorrhagic stroke might predict superior cognitive recovery among middle-aged individuals 10 years after stroke. 

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  • 8.
    Elgh, Eva
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Subjective and Objective Assessments of Executive Functioning among Persons 10 years after Stroke Onset2021Ingår i: Neuroscience and Neurological Surgery, E-ISSN 2578-8868, Vol. 10, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: This study aimed to investigate executive functioning (EF) among patients 10 years after stroke onset through comparing subjective patients’ and informants’ perceptions as well as objective neuropsychological assessments (NPAs).

    Materials and Method: One month prior to the neuropsychological assessment, 36 patients and their informants completed the Behaviour Rating Inventory of Executive Function - Adult Version (Brief-A) around 10 years after stroke onset. The patients’ EF was assessed with verbal fluency (FAS), backward Digit span backward and Trail making test (TMT)-B. 

    Results: We found no significant differences between patient and informant ratings on EF on a group level, but more patients reported clinically significant executive dysfunctions (T > 65) than their informants. Only poor to slight agreements were observed between the patient and informant ratings of the BRIEF-A.  Digit span backward was the only executive test that demonstrated significant improvement of EF 10 years post-stroke in the cohort. Neither patient nor informant ratings on EF showed any significant association with objective EF test performance.

    Conclusions: Mismatch patient-informant agreement on perceived executive dysfunction showed no clear association with EF test performance in this study. This may indicate the complexity of EF among persons with stroke at chronic phase. 

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  • 9.
    Elgh, Eva
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Visuospatial Function at Sub-Acute Phase Predicts Fatigue 10 Years After Stroke2020Ingår i: Frontiers in Neurology, E-ISSN 1664-2295, Vol. 11, artikel-id 562706Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and Objective: Fatigue is common among stroke survivors; and has significant negative consequences. However, long-term follow-up on post-stroke fatigue and it's association with cognitive and physiological parameters remains vague.

    Methods: A prospective cohort study was carried out on 38 young stroke survivors (aged 18–65 at stroke onset) living in the community 10 years after first-ever stroke. Fatigue was assessed by Fatigue assessment scale (FAS). Global cognition and cognitive sub-domains were assessed repeatedly at 1 week, 7 months, and 10 years after their first-ever stroke. Univariate correlation analysis was used to investigate associations and multivariate regression was used to investigate predictors and association with fatigue.

    Results: At 10-years follow-up after stroke onset, more than half of the 38 participants suffered from fatigue [with median score 25 on FAS with 25–75% percentile (21–28)]. Most of them were independent in their everyday life [mRS median score 1 (0–2)]. In univariate correlation analyses, higher fatigue score was significantly correlated to higher independence in the daily activity, higher BMI, anxiety, higher scores on global cognition and better working memory at 10-years follow-up as well as better visuospatial functions after 7 months and 10-years. In a multiple regression analysis, only visuospatial function at 7-months follow-up was a significant predictor of fatigue 10 years after stroke onset [F = 23.07, p < 0.009], with adjusted (R2 = 0.815) i.e., higher scores on Block design were associated with more fatigue.

    Conclusion: Our results extended the time course of post-stroke fatigue up to 10 years after stroke onset. The participants with more fatigue performed better in cognitive assessments and daily activity, which indicated dissociation between fatigue and fatigability among stroke patients. Visuospatial function at the sub-acute phase predicted independently late post-stroke fatigue. This may offer a broad time window for rehabilitation and information about fatigue. The clinical implications of the current findings are worth to be studied further.

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  • 10.
    Eriksson, Johan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI).
    Nyberg, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB). Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper.
    Elgh, Eva
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Improvement of cognition across a decade after stroke correlates with the integrity of functional brain networks2023Ingår i: NeuroImage: Clinical, E-ISSN 2213-1582, Vol. 37, artikel-id 103356Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and objective: We recently reported improvements of working memory across 10 years post stroke among middle-aged individuals. However, the mechanisms underlying working-memory recovery are largely unknown. This study investigated the associations between long-term improvement of working memory and resting-state functional connectivity in two frontoparietal networks: the frontoparietal network and the dorsal attention network.

    Methods: Working memory was repeatedly assessed by the Digit Span Backwards task in 21 persons, within 1 year after stroke onset and again 10 years post stroke onset. Brain functional connectivity was examined by resting state functional magnetic resonance imaging at the 10-year follow-up.

    Results: A significant improvement of working memory was found among 21 persons after stroke (median age = 64) at the 10-year follow-up compared to the within-one-year assessment. The magnitude of performance improvement on the Digit Span Backwards task was significantly positively correlated with stronger brain connectivity in the frontoparietal network (r = 0.51, p = 0.018) measured at the 10-year follow-up only. A similar association was observed in the dorsal attention network (r = 0.43, p = 0.052) but not in a visual network (r = -0.17, p = 0.46) that served as a control network. The association between functional connectivity within the above-mentioned networks and Digit Span Backwards scores at 10-year after stroke was in the same direction but did not reach significance.

    Conclusions: The present work relate stronger long-term performance improvement on the Digit Span Backwards task with higher integrity of frontoparietal network connectivity.

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  • 11.
    Ertzgaard, Per
    et al.
    Linköping University.
    Hu, Xiaolei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Levi, Richard
    Linköping University.
    Bilaga 1 - Förslag på kursämnen för rehabiliteringsmedicin2014Övrigt (Övrigt vetenskapligt)
  • 12.
    Hellström, Thomas
    et al.
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. University Hospital of Northern Sweden, Umeå, Sweden.
    Lindahl, Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. University Hospital of Northern Sweden, Umeå, Sweden.
    Bäcklund, Tomas
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. University Hospital of Northern Sweden, Umeå, Sweden.
    Karlsson, Marcus
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. University Hospital of Northern Sweden, Umeå, Sweden.
    Hohnloser, Peter
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Institutionen för datavetenskap. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. University Hospital of Northern Sweden, Umeå, Sweden.
    Bråndal, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. University Hospital of Northern Sweden, Umeå, Sweden.
    Hu, Xiaolei
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. University Hospital of Northern Sweden, Umeå, Sweden; Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Sweden.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. University Hospital of Northern Sweden, Umeå, Sweden.
    An intelligent rollator for mobility impaired persons, especially stroke patients2016Ingår i: Journal of Medical Engineering & Technology, ISSN 0309-1902, E-ISSN 1464-522X, Vol. 40, nr 5, s. 270-279Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Apoptotic and necrotic cell death after photothrombotic ring stroke: characterization of a stroke model and its morphological and molecular consequences2003Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    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.

  • 14.
    Hu, Xiaolei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Bedömning och handläggning av kognitiv nedsättning efter stroke2016Konferensbidrag (Övrigt vetenskapligt)
  • 15.
    Hu, Xiaolei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Evidensbaserade interventioner för nedre extremitet efter stroke2016Konferensbidrag (Övrigt vetenskapligt)
  • 16.
    Hu, Xiao-Lei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Bergström, Sven-Anders
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Brink, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Rönnbäck, Annica
    Karolinska Institute, Dept NVS, KI-Alzheimer Disease Research Center, KASPAC, Novum, SE-141 57 Huddinge, Sweden.
    Dahlqvist, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Enriched environment increases spinophilin mRNA expression and spinophilin immunoreactive dendritic spines in hippocampus and cortex2010Ingår i: Neuroscience Letters, ISSN 0304-3940, E-ISSN 1872-7972, Vol. 476, nr 2, s. 79-83Artikel i tidskrift (Refereegranskat)
    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.

  • 17.
    Hu, XiaoLei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Brännström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Gu, Weigang
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    A photothrombotic ring stroke model in rats with or without late spontaneous reperfusion in the region at risk1999Ingår i: Brain Research, ISSN 0006-8993, E-ISSN 1872-6240, Vol. 849, nr 1-2, s. 175-186Artikel i tidskrift (Refereegranskat)
    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.

  • 18.
    Hu, Xiaolei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Heyn, Patricia C.
    Schwartz, Jaclyn
    Roberts, Pamela
    What Is Mild Stroke?2017Ingår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 98, nr 11, s. 2347-2349Artikel i tidskrift (Refereegranskat)
  • 19.
    Hu, XiaoLei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Johansson, Inga-Maj
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi.
    Brännström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Long-lasting neuronal apoptotic cell death in regions with severe ischemia after photothrombotic ring stroke in rats2002Ingår i: Acta Neuropathologica, ISSN 0001-6322, E-ISSN 1432-0533, Vol. 104, nr 5, s. 462-70Artikel i tidskrift (Refereegranskat)
    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.

  • 20.
    Hu, Xiao-Lei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Jonzén, Karolina
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Karlsson, Marcus
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Lindahl, Olof A.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Assessments of a novel digital follow-up tool Rehabkompassen® to identify rehabilitation needs among stroke patients in an outpatient setting2022Ingår i: Digital Health, E-ISSN 2055-2076, Vol. 8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: It remains a huge challenge to identify individual rehabilitation needs in a time-efficient manner for providing patient-tailored rehabilitation during the continuum of stroke care. We have recently demonstrated the usefulness of a paper-version Rehab-Compass as a follow-up tool. The aim of the current study was to develop a digital version of the Rehab-Compass and evaluate its usability and feasibility.

    Methods: The novel digital tool Rehabkompassen® was developed by an iterative and participatory design process. Patients' rehabilitation needs were visualized by the tool and used before, during, and after the consultation. The usability and feasibility of the tool was assessed by task completion rate, the System Usability Scale, and satisfaction questionnaires among 2 physicians and 24 adult stroke patients in an outpatient clinical setting.

    Results: Rehabkompassen® identified and graphically visualized a panoramic view of the stroke patients' multidimensional needs in individual- and group levels. The instrument appeared to be feasible and time efficient in clinical use with a 100% overall task completion rate for both patients and physicians. A majority of the patients reported that it was very easy or fairly easy to answer the digital questionnaires and to understand their own digital Rehab-Compass graph. Two physicians reported a high mean score on the System Usability Scale (95/100) and were positive about using the tool in the future.

    Conclusions: The current results indicated that Rehabkompassen® was a feasible, useful, and time-saving follow-up tool for the identification of rehabilitation needs among stroke survivors in the post-acute continuum of care after stroke. Further research is needed to evaluate the efficacy of the digital instrument among stroke patients.

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  • 21.
    Hu, Xiao-Lei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Jonzén, Karolina
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik. Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Centrum för medicinsk teknik och fysik (CMTF).
    Lindahl, Olof A
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Centrum för medicinsk teknik och fysik (CMTF). Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Karlsson, Marcus
    Umeå universitet, Teknisk-naturvetenskapliga fakulteten, Centrum för medicinsk teknik och fysik (CMTF). Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lundström, Erik
    Department of Medical Sciences, Neurology, Akademiska Sjukhuset, Uppsala University, Uppsala, Sweden.
    Stibrant Sunnerhagen, Katharina
    Department of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg University, Gothenburg, Sweden.
    Digital Graphic Follow-up Tool (Rehabkompassen) for Identifying Rehabilitation Needs among People after Stroke: Randomized Clinical Feasibility Study2022Ingår i: JMIR Human Factors, E-ISSN 2292-9495, Vol. 9, nr 3, artikel-id e38704Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Stroke is a leading cause of disability among adults, with heavy social and economic burden worldwide. A cost-effective solution is urgently needed to facilitate the identification of individual rehabilitation needs and thereby provide tailored rehabilitations to reduce disability among people who have had a stroke. A novel digital graphic follow-up tool Rehabkompassen has recently been developed to facilitate capturing the multidimensional rehabilitation needs of people who have had a stroke.

    Objective: The aim of this study was to evaluate the feasibility and acceptability of conducting a definitive trial to evaluate Rehabkompassen as a digital follow-up tool among people who have had a stroke in outpatient clinical settings.

    Methods: This pilot study of Rehabkompassen was a parallel, open-label, 2-arm prospective, proof-of-concept randomized controlled trial (RCT) with an allocation ratio of 1:1 in a single outpatient clinic. Patients who have had a stroke within the 3 previous months, aged ≥18 years, and living in the community were included. The trial compared usual outpatient visits with Rehabkompassen (intervention group) and without Rehabkompassen (control group) at the 3-month follow-up as well as usual outpatient visit with Rehabkompassen at the 12-month follow-up. Information on the recruitment rate, delivery, and uptake of Rehabkompassen; assessment and outcome measures completion rates; the frequency of withdrawals; the loss of follow-up; and satisfaction scores were obtained. The key outcomes were evaluated in both groups.

    Results: In total, 28 patients (14 control, 14 Rehabkompassen) participated in this study, with 100 patients screened. The overall recruitment rate was 28% (28/100). Retention in the trial was 86% (24/28) at the 12-month follow-up. All participants used the tool as planned during their follow-ups, which provided a 100% (24/24) task completion rate of using Rehabkompassen and suggested excellent feasibility. Both patient- and physician-participants reported satisfaction with the instrument (19/24, 79% and 2/2, 100%, respectively). In all, 2 (N=2, 100%) physicians and 18 (N=24, 75%) patients were willing to use the tool in the future. Furthermore, modified Rankin Scale as the primary outcome and various stroke impacts as secondary outcomes were both successfully collected and compared in this study.

    Conclusions: This study demonstrated the high feasibility and adherence of the study protocol as well as the high acceptability of Rehabkompassen among patients who have had a stroke and physicians in an outpatient setting in comparison to the predefined criterion. The information collected in this feasibility study combined with the amendments of the study protocol may improve the future definitive RCT. The results of this trial support the feasibility and acceptability of conducting a large definitive RCT.

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  • 22.
    Hu, Xiao-Lei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Liv, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Lundström, Erik
    Department of Medical Sciences, Neurology, Uppsala University, Akademiska Sjukhuset, Uppsala, Sweden.
    Norström, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Lindahl, Olof A
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Radiofysik.
    Borg, Kristian
    Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
    Sunnerhagen, Katharina S.
    Department of Neuroscience and Physiology, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Study protocol for a randomized, controlled, multicentre, pragmatic trial with Rehabkompassen®: a digital structured follow-up tool for facilitating patient-tailored rehabilitation in persons after stroke2023Ingår i: Trials, E-ISSN 1745-6215, Vol. 24, nr 1, artikel-id 650Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Stroke is a leading cause of disability among adults worldwide. A timely structured follow-up tool to identify patients’ rehabilitation needs and develop patient-tailored rehabilitation regimens to decrease disability is largely lacking in current stroke care. The overall purpose of this study is to evaluate the effectiveness of a novel digital follow-up tool, Rehabkompassen®, among persons discharged from acute care settings after a stroke.

    Methods: This multicentre, parallel, open-label, two-arm pragmatic randomized controlled trial with an allocation ratio of 1:1 will be conducted in Sweden. A total of 1106 adult stroke patients will have follow-up visits in usual care settings at 3 and 12 months after stroke onset. At the 3-month follow-up, participants will have a usual outpatient visit without (control group, n = 553) or with (intervention group, n = 553) the Rehabkompassen® tool. All participants will receive the intervention at the 12-month follow-up visit. Feedback from the end-users (patient and health care practitioners) will be collected after the visits. The primary outcomes will be the patients’ independence and social participation at the 12-month visits. Secondary outcomes will include end-users’ satisfaction, barriers and facilitators for adopting the instrument, other stroke impacts, health-related quality of life and the cost-effectiveness of the instrument, calculated by incremental cost per quality-adjusted life year (QALY).

    Discussion: The outcomes of this trial will inform clinical practice and health care policy on the role of the Rehabkompassen® digital follow-up tool in the post-acute continuum of care after stroke.

    Trial registration: ClinicalTrials.gov NCT04915027. Registered on 4 June 2021. ISRCTN registry ISRCTN63166587. Registered on 21 August 2023.

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  • 23.
    Hu, Xiao-Lei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Olsson, Tommy
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Johansson, Inga-Maj
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Obstetrik och gynekologi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Brännström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi. Umeå Stroke Centre, Umeå University Hospita.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    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 rats2004Ingår i: European Journal of Neuroscience, ISSN 0953-816X, E-ISSN 1460-9568, Vol. 20, nr 5, s. 1177-1188Artikel i tidskrift (Refereegranskat)
    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.

  • 24.
    Hu, Xiao-Lei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Stibrant Sunnerhaagen, Katharina
    professor, överläkare, sektionen för klinisk neurovetenskap, institutionen för neurovetenskap och fysiologi, Göteborg universitet; Sahlgrenska universitetssjukhuset, Göteborg.
    Vårdkedjan för strokerehab – så kan den bli kostnadseffektiv2021Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118, nr 36-37, artikel-id 20230Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A stroke is the most common cause for disability in the adult population. Rehabilitation is the tool to reduce the consequences of impairment. However, the continuum of stroke care is fragmented and rehabilitation is often lacking and unevenly distributed along the care pathway. In order to find potential cost-effective solutions, we have analysed the Swedish stroke care service system by using a three-level framework, i.e. micro, meso, and macro levels. At the micro level, a standardized and regular follow-up including assessment of rehabilitation needs is needed to facilitate effective rehabilitation and timely transition of care. The evidence-based rehabilitation including increasing rehabilitation intensity should be implemented in the whole care chain. At the meso level, a tight collaboration between different medical specialities is necessary to build a cost-effective stroke care. The awareness of rehabilitation needs and possibilities to respond to these require increased education about rehabilitation for the health care staff. Both undergraduate teaching as well as speciality training should include rehabilitation. The use of tele-medicine can be a way forward to provide rehabilitation in the same manner for more people and in different parts of the country.  Together with these micro and meso level solutions, additional recourses need to be prioritized at the macro level in order to facilitate the improvement of the cost-effective continuum of stroke care.

  • 25.
    Hu, Xiao-Lei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Neurorehab, Neuro–huvud–hals­centrum, Norrlands universitetssjukhus, Umeå.
    Stibrant Sunnerhaagen, Katharina
    Sektionen för klinisk neurovetenskap, institutionen för neurovetenskap och fysiologi, Göteborg universitet; Sahlgrenska universitetssjukhuset, Göteborg.
    Vårdkedjan för strokerehab: så kan den bli kostnadseffektiv2021Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118, artikel-id 20230Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A stroke is the most common cause for disability in the adult population. Rehabilitation is the tool to reduce the consequences of impairment. However, the continuum of stroke care is fragmented and rehabilitation is often lacking and unevenly distributed along the care pathway. In order to find potential cost-effective solutions, we have analysed the Swedish stroke care service system by using a three-level framework, i.e. micro, meso, and macro levels. At the micro level, a standardized and regular follow-up including assessment of rehabilitation needs is needed to facilitate effective rehabilitation and timely transition of care. The evidence-based rehabilitation including increasing rehabilitation intensity should be implemented in the whole care chain. At the meso level, a tight collaboration between different medical specialities is necessary to build a cost-effective stroke care. The awareness of rehabilitation needs and possibilities to respond to these require increased education about rehabilitation for the health care staff. Both undergraduate teaching as well as speciality training should include rehabilitation. The use of tele-medicine can be a way forward to provide rehabilitation in the same manner for more people and in different parts of the country.  Together with these micro and meso level solutions, additional recourses need to be prioritized at the macro level in order to facilitate the improvement of the cost-effective continuum of stroke care.

  • 26.
    Hu, Xiao-Lei
    et al.
    Neurorehab, Neuro-Huvud-Hals Centrum / Norrlands Universitetssjukhus.
    Stibrant Sunnerhagen, Katharina
    Stroke, rehabilitering2018Övrigt (Refereegranskat)
  • 27.
    Hu, Xiaolei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Brännström, Thomas
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Watson, Brant D.
    Cerebrovascular Disease Research Center, Departments of Neurology and Biomedical Engineering, University of Miami, Miami, FL 33101, USA.
    Gu, WeiGang
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Progressive and reproducible focal cortical ischemia with or without late spontaneous reperfusion generated by a ring-shaped, laser-driven photothrombotic lesion in rats2001Ingår i: Brain Research Protocols, ISSN 1385-299X, E-ISSN 1872-809X, Vol. 7, nr 1, s. 76-85Artikel i tidskrift (Refereegranskat)
    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.

  • 28.
    Hu, Xiao-Lei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Wester, Per
    Karolinska institutet, Institutionen för kliniska vetenskaper, Danderyds sjukhus, Stockholm, Sweden.
    Stibrant Sunnerhagen, Katharina
    Institutionen för neurovetenskap och fysiologi, Göteborgs universitet, Sahlgrenska universitetssjukhuset, Göteborg, Sweden.
    Evidensbaserad rehabilitering efter stroke med nya riktlinjer: [Evidence-based methods in the clinical practice in updated Swedish national stroke guidelines]2018Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, nr 51-52, artikel-id FDIXArtikel i tidskrift (Refereegranskat)
    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 evidencebased 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 arly 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.

  • 29.
    Hu, Xiao-Lei
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin. Neurocentrum, NUS.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Stibrant Sunnerhagen, Katharina
    Rehabilitering efter stroke - Socialstyrelsens strokeriktlinjer medför nya utmaningar2018Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, nr 51-52, artikel-id FDIXArtikel i tidskrift (Refereegranskat)
    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.

  • 30. Kim, Sonya
    et al.
    Capo-Lugo, Carmen
    Reed, William R.
    Vora, Ariana
    Ehsanian, Reza
    Krishnan, Shilpa
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Galantino, Mary Lou
    Mortera, Marianne H.
    Beattie, Aaron
    Sasson, Nicole
    Theodore, Brian R.
    Erb, Matt
    Heyn, Patricia
    Using a Survey to Characterize Rehabilitation Professionals' Perceptions and Use of Complementary, Integrative, and Alternative Medicine2020Ingår i: Journal of Alternative and Complementary Medicine, ISSN 1075-5535, E-ISSN 1557-7708, Vol. 26, nr 8, s. 663-665Artikel i tidskrift (Refereegranskat)
  • 31.
    Kim, Sonya
    et al.
    Department of Neurology and Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, United States.
    Mortera, Marianne
    NYU Steinhardt, Department of Occupational Therapy, New York University, New York, United States.
    Heyn, Patricia
    Marymount Center for Optimal Aging, School of Health Sciences, College of Health and Education, Marymount University, VA, Arlington, United States.
    Sood, Pallavi
    Marymount Center for Optimal Aging, School of Health Sciences, College of Health and Education, Marymount University, VA, Arlington, United States.
    Wen, Pey-Shan
    Lewis College of Nursing Health Professions, Georgia State University, GA, Atlanta, United States.
    Chen Wong, Diana
    NYU Steinhardt, Department of Occupational Therapy, New York University, New York, United States.
    Tanveer, Sarah
    Department of Pharmaceutical Health Services Research, University of Maryland, MD, Baltimore, United States.
    Hu, Xiaolei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    An overview of systematic reviews on the pharmacological randomized controlled trials for reducing intracranial pressure after traumatic brain injury2022Ingår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 36, nr 7, s. 829-840Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: There is a need for an overview of systematic reviews (SRs) examining randomized clinical trials (RCTs) of pharmacological interventions in the treatment of intracranial pressure (ICP) post-TBI.

    Objectives: To summarize pharmacological effectiveness in decreasing ICP in SRs with RCTs and evaluate study quality.

    Methods: Comprehensive literature searches were conducted in MEDLINE, PubMed, EMBASE, PsycINFO, and Cochrane Library databases for English SRs through October 2020. Inclusion criteria were SRs with RCTs that examined pharmacological interventions to treat ICP in patients post-TBI. Data extracted were participant characteristics, pharmacological interventions, and ICP outcomes. Study quality was assessed with AMSTAR-2.

    Results: Eleven SRs between 2003 and 2020 were included. AMSTAR-2 ratings revealed 3/11 SRs of high quality. Pharmacological interventions included hyperosmolars, neuroprotectives, anesthetics, sedatives, and analgesics. Study samples ranged from 7 to 1282 patients. Hyperosmolar agents and sedatives were beneficial in lowering elevated ICP. High bolus dose opioids had a more deleterious effect on ICP. Neuroprotective agents did not show any effects in ICP management. RCT sample sizes and findings in the SRs varied. A lack of detailed data syntheses was noted. AMSTAR-2 analysis revealed moderate-to-high quality in most SRs. Future SRs may focus on streamlined reporting of dosing and clearer clinical recommendations.

    Conclusions: PROSPERO-Registration: CRD42015017355.

  • 32. Kim, Sonya
    et al.
    Mortera, Marianne
    Hoffecker, Lilian
    Herrold, Amy
    King, Laurie
    Terhorst, Lauren
    Hu, Xiaolei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Shilpa, Krishnan
    Machtinger, Joseph
    Heyn, Patricia
    An Umbrella Review of Systematic Reviews of Pharmacological Treatments Post-TBI2017Ingår i: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 98, nr 10, s. 142-Artikel i tidskrift (Refereegranskat)
  • 33. Kim, Sonya
    et al.
    Mortera, Marianne
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    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 outcomes2019Ingår i: Brain Injury, ISSN 0269-9052, E-ISSN 1362-301X, Vol. 33, nr 4, s. 442-455Artikel i tidskrift (Refereegranskat)
    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.

  • 34. Kletzel, Sandra L.
    et al.
    Sood, Pallavi
    Negm, Ahmed
    Heyn, Patricia C.
    Krishnan, Shilpa
    Machtinger, Joseph
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Neurocentrum, NUS.
    Devos, Hannes
    Effectiveness of Brain Gaming in Older Adults With Cognitive Impairments: A Systematic Review and Meta-Analysis.2021Ingår i: Journal of the American Medical Directors Association, ISSN 1525-8610, E-ISSN 1538-9375, Vol. 22, nr 11, s. 2281-2288Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: This systematic review and meta-analysis evaluates the evidence from randomized clinical trials (RCTs) that designed brain gaming interventions to improve cognitive functions of older adults with cognitive impairments, including mild cognitive impairments and dementia.

    DESIGN: Systematic review and meta-analysis.

    SETTING AND PARTICIPANTS: N/A.

    MEASURES: N/A.

    METHODS: Data sources-relevant randomized control trials (RCTs) were identified by a systematic search of databases including Medline, PubMed, PsycINFO, Embase, CINAHL, Web of Science, and Cochrane. RCTs were selected first based on title and abstract review and then on full-text review by independent reviewers using predefined eligibility criteria. Risk of bias (RoB) was assessed using the Cochrane RoB tool and funnel plots. The primary outcome variable was the composite score of global cognitive function.

    RESULTS: A total of 909 participants with mild cognitive impairment or dementia from 16 RCTs were included in the systematic review. The study quality was modest, and the RoB assessment showed bias in blinding the participants and personnel. Funnel plots showed no evidence of publication bias. The meta-analysis of 14 RCTs revealed no superior effect of brain gaming compared to other interventions on global cognitive function (pooled standardized mean difference = 0.08, 95% confidence interval -0.24, 0.41, P = .61, I2 = 77%). Likewise, no superior effects were found on the cognitive domains of memory, executive function, visuospatial skills, and language.

    CONCLUSION AND IMPLICATIONS: The findings of this meta-analysis suggest that brain gaming compared with the control intervention does not show significant improvement in standardized tests of cognitive function. Because of considerable heterogeneity in sample size, gaming platform, cognitive status, study design, assessment tools, and training prescription, we cannot confidently refute the premise that brain gaming is an effective cognitive training approach for older adults with cognitive impairments. Recommendations for future research are included.

  • 35.
    Lexell, Jan
    et al.
    Lunds universitet; Skånes universitetssjukhus Lund.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Rehabiliteringsmetodiken är läkarspecialitetens kärnpunkt2021Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118, artikel-id 21028Artikel i tidskrift (Refereegranskat)
  • 36.
    Lexell, Jan
    et al.
    professor i rehabiliteringsmedicin, överläkare, Lunds universitet; Skånes universitetssjukhus Lund.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Rehabiliteringsmetodiken är läkarspecialitetens kärnpunkt2021Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 118, nr 36-37, artikel-id 21028Artikel i tidskrift (Refereegranskat)
  • 37.
    Magaard, Gustaf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Öhberg, Fredrik
    Department of Radiation Sciences/Biomedical Engineering, University Hospital of Northern Sweden, Umeå, Sweden.
    Berggren, Stina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Grollmuss, Emma
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Identifying sub-acute rehabilitation needs among individuals after transient ischaemic attack using rehab-compass as a simple screening tool in the outpatient clinic2019Ingår i: Journal of Rehabilitation clinical communications, E-ISSN 2003-0711, Vol. 2, artikel-id 1000018Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To evaluate comprehensive unmet rehabilitation needs by using a novel graphic screening tool, Rehab-Compass, among individuals in the sub-acute stage after first-ever transient ischaemic attack.

    Methods: A pilot prospective cohort study investigated 47 individuals with first-ever transient ischaemic attack in an outpatient clinic setting. By using Rehab-Compass, based on well-validated patient-reported outcome measure questionnaires, this study examined comprehensive unmet rehabilitation needs among individuals at 4-month follow-up after the onset of transient ischaemic attack.

    Results: Rehab-Compass identified that most participants were independent in their daily lives (modified Rankin Scale; mRS 0–1) with a relatively good quality of life (median EuroQol 5 dimensions (EQ-5D) 0.85), but certain limitations in participation in their daily lives. Rehab-Compass showed that, at 4 months after transient ischaemic attack, the most common condition affected was mood (reported by 89% of participants), followed by bladder function (70%), sexual life (52%), strength (51%) and fatigue (26%). Symptoms of depression and anxiety were reported by 6% and 17% of participants, respectively.

    Conclusion: This pilot study indicates that Rehab-Compass might be a suitable simple screening tool for use in the outpatient clinic setting to identify the multidimensional rehabilitation needs of individuals after transient ischaemic attack.

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  • 38.
    Magaard, Gustaf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Levi, Richard
    Lindvall, Peter
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Gustafsson, Emma
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Nazemroaya Sedeh, Arzhang
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Lönnqvist, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Berggren, Stina
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Nyman, Kristin
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Neurocentrum, NUS.
    Identifying unmet rehabilitation needs in patients after stroke with a graphic rehab-compassTM2018Ingår i: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 27, nr 11, s. 3224-3235Artikel i tidskrift (Refereegranskat)
    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.

  • 39.
    Marklund, Ingela
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Fure, Brynjar
    Klässbo, Maria
    Liv, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Stålnacke, Britt-Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS). Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Six minute walk performance predicts physical functioning in health related quality of life after lower-extremity constraint-induced movement therapy post-stroke: a cross-sectional survey studyManuskript (preprint) (Övrigt vetenskapligt)
  • 40.
    Marklund, Ingela
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Sefastsson, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Liljeholmskliniken, Stockholm, Sweden.
    Fure, Brynjar
    Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden;School of Medical Sciences, Örebro University, Örebro, Sweden.
    Klässbo, Maria
    Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Liv, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Lower-extremity constraint-induced movement therapy improved motor function, mobility, and walking after stroke2023Ingår i: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, Vol. 59, nr 2, s. 136-144Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: To regain the ability to walk is one of the most commonly stated goals for people who have had a stroke due to its importance in everyday life. Walking ability affects patients’ mobility, self-care, and social lives. Constraint-induced movement therapy (CIMT) is known to be effective in improving upper extremity outcomes post-stroke. However, there is insufficient evidence regarding its efficacy in improving lower extremity outcomes.AIM: To investigate whether a highly intensive CIMT for lower extremity (LE-CIMT) function post-stroke can improve motor function, functional mobility, and walking ability. Furthermore, it also aimed to investigate whether age, gender, stroke type, more-affected side, or time after stroke onset affect the efficacy of LE-CIMT on walking ability outcomes.

    DESIGN: Longitudinal cohort study.

    SETTING: Outpatient clinic in Stockholm, Sweden.

    POPULATION: A total of 147 patients mean age 51 years (68% males; 57% right-sided hemiparesis), at the sub-acute or chronic phases post-stroke who had not previously undergone LE-CIMT.

    METHODS: All patients received LE-CIMT for 6 hours per day over 2 weeks. The Fugl-Meyer Assessment (FMA) of the lower extremity, Timed Up and Go (TUG) test, Ten-Meter Walk Test (10MWT), and six-Minute Walk Test (6MWT) were used to assess functional outcomes before and directly after the 2-week treatment was complete as well at 3-month post-intervention.

    RESULTS: Compared to baseline values, FMA (P<0.001), TUG (P<0.001), 10MWT (P<0.001) and 6MWT (P<0.001) scores were statistically significantly improved directly after the LE-CIMT intervention. These improvements persisted at the 3-month post-intervention follow-up. Those who completed the intervention 1-6 months after stroke onset had statistically significant larger improvements in 10MWT compared to those who received the intervention later than 6 months after stroke onset. Age, gender, stroke type, and more-affected side did not impact 10MWT results.

    CONCLUSIONS: In an outpatient clinic setting, high-intensity LE-CIMT statistically significant improved motor function, functional mobility, and walking ability in middle-aged patients in the sub-acute and chronic post-stroke phases. However, studies with more robust designs need to be conducted to deepen the understanding of the efficacy of LE-CIMT.

    CLINICAL REHABILITATION IMPACT: High-intensity LE-CIMT may be a feasible and useful treatment option in outpatient clinics to improve post-stroke walking ability.

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  • 41. Schwartz, Jaclyn K.
    et al.
    Capo-Lugo, Carmen E.
    Akinwuntan, Abiodun Emmanuel
    Roberts, Pamela
    Krishnan, Shilpa
    Belagaje, Samir R.
    Kovic, Mark
    Burns, Suzanne Perea
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Danzl, Megan
    Devos, Hannes
    Page, Stephen J.
    Classification of Mild Stroke: A Mapping Review2019Ingår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 11, nr 9, s. 996-1003Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Persons with mild stroke experience motor and cognitive impairments that negatively affect their health and quality of life. To address these deficits, it is essential for clinicians and researchers to precisely identify mild stroke survivors. Despite the fact that half of all strokes are categorized as mild, no standards exist on what constitutes a "mild" stroke. The purpose of this study is to summarize the current classification of mild stroke using a mapping review approach. Strategies to categorize "mild stroke" severity were explored in 188 papers indexed in the PubMed database. The results indicate that there was substantial variability in the procedures and scoring criteria used to determine mild stroke. To identify persons with mild stroke, researchers have largely applied assessment instruments developed to inform acute stroke care (eg, National Institutes of Health Stroke Scale, Modified Rankin Scale, Barthel Index). Unfortunately, these approaches demonstrate floor effects and fail to detect the long-term disabling impairments that often limit the outcomes of mild stroke survivors. Additional research is warranted to suggest an evidence-based mild stroke categorization strategy that enhances diagnosis, treatment, and referral decisions to the benefit of mild stroke survivors.

  • 42. Schwartz, Jaclyn
    et al.
    Thomas, Lauren
    Belagaje, Samir
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Salinas, Paige
    Terrill, Alexandra
    STROKE HOT TOPICS: Addressing Mental Health in Stroke Rehabilitation2018Konferensbidrag (Refereegranskat)
    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
  • 43.
    Sefastsson, Annika
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Marklund, Ingela
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Littbrand, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Geriatrik. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
    Wester, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Stålnacke, Britt-Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS). Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Sörlin, Ann
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Langhammer, Birgitta
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Improved balance, leg strength, and dual-task ability after lower extremity constraint-induced movement therapy in stroke patients: a longitudinal cohort studyManuskript (preprint) (Övrigt vetenskapligt)
  • 44. Sood, Pallavi
    et al.
    Kletzel, Sandra L.
    Krishnan, Shilpa
    Devos, Hannes
    Negm, Ahmed
    Hoffecker, Lilian
    Machtinger, Joseph
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering. Neurocentrum, NUS.
    Heyn, Patricia C.
    Nonimmersive Brain Gaming for Older Adults With Cognitive Impairment: A Scoping Review2019Ingår i: The Gerontologist, ISSN 0016-9013, E-ISSN 1758-5341, Vol. 59, nr 6, s. E764-E781Artikel, forskningsöversikt (Refereegranskat)
    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.

  • 45.
    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 universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Symposium Sexuality and neurorehabilitation2016Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    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

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

  • 46. Wang, Rongrong
    et al.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Zhang, Tong
    Fugl-Meyer, Kerstin Sjögren
    Langhammer, Birgitta
    Cross-cultural adaptation of Life Satisfaction Checklist-11 among persons with stroke in China: A reliability and validity study2021Ingår i: Physiotherapy Research International, ISSN 1358-2267, E-ISSN 1471-2865, Vol. 26, nr 2, artikel-id e1887Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of the present study was to develop a cross-cultural adaptation and to evaluate the validity and reliability of a Chinese version of the LiSat-11 test.

    Methods: LiSat-11 was translated into Chinese according to standardized procedures. A cross-sectional descriptive study was conducted to examine its reliability and validity, in accordance to COnsensus-based Standards for the election of health Measurements Instruments guidelines, among persons with stroke approximately 3 years after their discharge from rehabilitation. Participants completed the LiSat-11, 36-Item Short-Form Health Survey (SF-36), National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), Barthel Index (BI) and Hospital Anxiety and Depression Scale (HADS). To examine the test-retest reliability, thirty of these participants completed LiSat-11 again after 2 weeks.

    Results: In total, 60 persons with stroke were recruited. The Chinese version of LiSat-11 demonstrated good internal consistency with Cronbach's alphas at 0.82. Ceiling effects were found in five of the eleven items of LiSat-11, and there was a floor effect in one item. LiSat-11 had moderate to high correlations with SF-36 with Spearman's correlation coefficient (rho) ranging from 0.44 to 0.73 (p < 0.01) in a concurrent validity test, and high correlations were also found between LiSat-11 and HADS-A/D in a convergent validity test with rho = -0.63/-0.67 (p < 0.01). Low correlations with NIHSS, BI and mRS were found in a divergent validity test, rho = -0.25, 0.17 and -0.26, respectively.

    Conclusion: The current study verified that the translated Chinese version of the Life Satisfaction Checklist-11 is a reliable and valid tool for measuring the life satisfaction of persons with chronic stroke.

  • 47.
    Wen, Pey-Shan
    et al.
    Department of Occupational Therapy, Byrdine F. Lewis College of Nursing and Health Professions, Georgia State University, GA, Atlanta, United States.
    Vora, Ariana
    Department of Physical Medicine & Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Network, MA, Boston, United States.
    Mortera, Marianne
    Department of Occupational Therapy, New York University, NY, New York, United States.
    Sasson, Nicole
    Department of Veterans Affairs – New York Harbor Healthcare System, Department of Rehabilitation Medicine-Rusk Rehabilitation, New York University Grossman School of Medicine, NY, New York, United States.
    Reed, William R.
    Department of Physical Therapy, University of Alabama at Birmingham, AL, Birmingham, United States.
    Ehsanian, Reza
    Division of Physical Medicine and Rehabilitation, Department of Orthopedics & Rehabilitation, University of New Mexico School of Medicine, NM, Albuquerque, United States.
    Galantino, Mary Lou
    Doctoral Physical Therapy Program, Stockton University, NJ, Galloway, United States; School of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.
    Erb, Matt
    The Center for Mind-Body Medicine, NW, Washington D.C., United States.
    Hu, Xiao-Lei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Kim, Sonya
    Departments of Neurology and Rehabilitation Medicine, NYU Grossman School of Medicine, NY, New York, United States.
    Perceptions and use of complementary and integrative health practices among rehabilitation professionals: a survey2022Ingår i: European Journal of Integrative Medicine, ISSN 1876-3820, E-ISSN 1876-3839, Vol. 55, artikel-id 102173Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Despite increasing use of complementary and integrative health (CIH) by rehabilitation providers, information on rehabilitation professionals’ perceptions and utilization of CIH is limited. The purpose of this study was to investigate rehabilitation professionals’ perceptions, utilization, barriers and research of CIH in the United States.

    Methods: A cross-sectional online survey was conducted on the perceptions, utilization, barriers and research regarding CIH. Survey invitations were posted on community boards of rehabilitation associations and sent to rehabilitation institutions listserv in 2020.

    Results: Of 405 respondents, the majority of respondents were physical therapists (PTs) (34%), then, occupational therapists (OTs) (20%), and physicians (16.8%). Most respondents (68%) worked in settings offering integrative health. Forty three percent of respondents were trained and 22% were certified in CIH practice. Breathing exercises, meditation, massage, and yoga were the most commonly utilized practices for self-care and patient care. Physicians and PTs were more likely than OTs to initiate discussion about CIH with patients (p=.001 and p=.046 respectively), and senior practitioners were more likely to initiate these discussions than junior practitioners (p=.037 and p<.001, respectively). Peer-reviewed publications, clinical experience, and personal experience with CIH were the most selected factors affecting respondents’ attitudes toward CIH practices. Rehabilitation clinicians reported that insufficient provider reimbursement and insufficient skills were the primary obstacles to CIH practice. Rehabilitation researchers reported that insufficient funding as the primary obstacle to conducting CIH research.

    Conclusions: Rehabilitation professionals commonly utilize CIH in practices for self-care and patient care, and they perceive insufficient training, clinical reimbursement and research funding as the main barriers to advancing CIH.

  • 48.
    Zampolini, Mauro
    et al.
    USL Umbria 2, Foligno Hospital, Perugia, Italy.
    Selb, Melissa
    ICF Research Branch, Nottwil, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland.
    Boldrini, Paolo
    Italian Society of Physical and Rehabilitation Medicine (SIMFER).
    Branco, Catarina A.
    Department of Physical and Rehabilitation Medicine - Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal.
    Golyk, Volodymyr
    Department of Physical and Rehabilitation Medicine and Sports Medicine, Shupyk National University of Healthcare of Ukraine, Kyiv, Ukraine; Department of Physical and Rehabilitation Medicine, City Municipal Teaching Hospital №4, Dnipro, Ukraine.
    Hu, Xiaolei
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Kiekens, Carlotte
    IRCCS Multimedica, Milano, Italy.
    Negrini, Stefano
    Department of Biomedical, Surgical and Dental Sciences, Università "La Statale", Milano, Italy; IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.
    Nulle, Anda
    National Rehabilitation Center "Vaivari", Jurmala, Latvia.
    Oral, Aydan
    Department of Physical Medicine and Rehabilitation, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
    Sgantzos, Markos
    Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
    Shmonin, Aleksei
    First Saint-Petersburg I.P.Pavlov State Medical University, Saint-Petersburg, Russia.
    Treger, Iuly
    Department of Rehabilitation, Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
    Stucki, Gerold
    ICF Research Branch, Nottwil, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland; Center for Rehabilitation in Global Health Systems, University of Lucerne, Switzerland.
    The Individual Rehabilitation Project as the core of person-centred rehabilitation: the Physical and Rehabilitation Medicine Section and Board of the European Union of Medical Specialists framework for rehabilitation in Europe2022Ingår i: European Journal of Physical and Rehabilitation Medicine, ISSN 1973-9087, E-ISSN 1973-9095, Vol. 58, nr 4, s. 503-510Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To facilitate the interaction between the health professional and the patient, a framework to guide the rehabilitation process is needed. This framework would encompass three interwoven aspects: the rehabilitation management plan, Individual Rehabilitation Project (IRP), and rehabilitation cycle(s). All three framework aspects focus on the patient and on the aim of rehabilitation, i.e. to optimize a person's functioning across the continuum of care. An IRP is a multi-element, person-centred rehabilitation management scheme, in which rehabilitation is generally provided by a multi-professional team under the leadership of a physical and rehabilitation medicine (PRM) physician, working in an interdisciplinary manner and together with the patient (or proxy). A reference system for operationalizing functioning and standardizing the process is the International Classification of Functioning, Disability and Health (ICF) - for assessing functioning needs, defining rehabilitation goals and outcomes. The objective of this paper is to present the IRP as a framework for rehabilitation in Europe (EUR-IRP). The specific aims are to 1) introduce the IRP and 2) describe the framework components, elements and variables of the IRP. Demonstration projects (case studies) using the EUR-IRP will be conducted. The present paper presents the efforts to date for developing the EUR-IRP, a key part of action plan of the PRM Section and Board of the European Union of Medical Specialists to implement the ICF systemwide across the care continuum. This paper serves as another step to bring together practice, science and governance in calling for contribution from rehabilitation clinicians and researchers and professional societies in PRM and beyond.

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