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  • 1.
    Bergman, Stefan
    et al.
    Lund University, Lund, Sweden & University of Gothenburg, Gothenburg, Sweden & RandD centre Spenshult, Halmstad, Sweden.
    Haglund, Emma
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). RandD centre Spenshult, Halmstad, Sweden.
    Aili, Katarina
    RandD centre Spenshult, Halmstad, Sweden & Karolinska Institutet, Stockholm, Sweden.
    Olsson, Cecilia
    University of Gothenburg, Gothenburg, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Lund University, Lund, Sweden & RandD centre Spenshult, Halmstad, Sweden.
    Chronic widespread pain, sleep problems and pressure pain thresholds in a population sample2018Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 7, nr 2, s. 1645-1646Artikkel i tidsskrift (Fagfellevurdert)
  • 2.
    Bremander, Ann
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Forslind, Kristina
    Lund University, Lund, Sweden & Helsingborg Hospital, Helsingborg, Sweden.
    Eberhardt, Kerstin
    Lund University, Lund, Sweden.
    Andersson, Maria L. E.
    Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Importance of Measuring Hand and Foot Function Over the Disease Course in Rheumatoid Arthritis: An Eight-Year Follow-Up Study2019Inngår i: Arthritis care & research, ISSN 2151-464X, E-ISSN 2151-4658, Vol. 71, nr 2, s. 166-172Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess function using the Signals of Functional Impairment (SOFI) instrument over 8 years, to study clinical variables associated with the change, and to study change over time of the SOFI items.

    Methods: In total, 1,223 patients with early rheumatoid arthritis (RA) from the Better Anti-Rheumatic Farmacotherapy (BARFOT) cohort (mean ± SD age 56.9 ± 15.4 years, 67% women) were included in the analysis. Data from baseline and from 1 and 8 years were studied. The SOFI instrument includes measures of range of motion in the hand, shoulder/arm, and lower extremity (range 0–44, best to worst). The effects of baseline variables (sociodemographic, disease activity, joint destruction, and function) on change in SOFI scores were studied by linear regression analysis.

    Results: During the first year, the improvement in mean ± SD SOFI scores was 2.7 ± 5.7 (P < 0.001). Worse scores in the Disease Activity Score in 28 joints and Health Assessment Questionnaire score at baseline were associated with this improvement (r2 <= 0.11). During the next 7 years, the deterioration in SOFI scores was mean ± SD 1.5 ± 4.9 (P < 0.001). Based on change scores, we found that finger flexion, pincer grip, and toe-standing were the most important items to measure, explaining 58-61% of the total SOFI score, and these items were also associated with radiographic changes at the 8-year follow-up.

    Conclusion: Function as assessed with SOFI scores improved during the first year in patients with early RA, but it deteriorated slowly thereafter. Impaired hand and foot function was associated with joint destruction at the 8-year follow-up. Measures of hand and foot function will complement self-reported and medical data, both in clinical work and in long-term research studies. Copyright © 2019, Emerald Publishing Limited

  • 3.
    Brorsson, S.
    et al.
    Health and Welfare, Dala Sports Academy, Dalarna University, Falun, Sweden.
    Thorstensson, C.
    Department of Clinical Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
    Nilsdotter, A.
    Department of Research and Education, Halmstad County Hospital, Halmstad, Sweden.
    Bremander, Ann
    Department of Clinical Sciences, Lund, Section of Rheumatology, Lund University, Lund, Sweden.
    Two different sets of handexercises improved grip strength after after eight weeks in patients with arthritis2014Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 73, nr Suppl. 2, s. 1210-1210Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background Hand function measured as grip force and finger extension force is often impaired in patients with rheumatoid arthritis (RA) and hand osteoarthritis (HOA) affecting performance of daily activities why hand exercises are recommended. A number of hand exercises are often used in the clinic but there is little information about “the effects of a minimal set of hand exercises” and if the choice of exercises is important to improve strength and function in the hand.

    Objectives To study the effect on grip- and finger extension strength and patient reported hand function from two different sets of handexercises performed over 8 weeks using a randomized study design.

    Methods Female patients with arthritis (RA and HOA, n=121) were randomly assigned to two different sets of handexercises (HE) for 8 weeks. The four hand exercises applied in the program were exercises commonly used in traditional hand training programs. The exercises were split into two groups depending on if the muscle activation (measured with EMG) were greater in forearm flexor (HE I, n=62) or in extensor muscles (HE II, n=59) (REF). HE I: isolated finger opposition (digits II-V) and rolling the putty with a flat hand, HE II: squeezing the putty and finger extension with putty resistance. The two HE were performed daily and each set was repeated 15 times, training time per day was maximum 5 minutes 7 days/week.

    Grip strength was measured with Grippit and finger extension strength with EX-it both validated instruments (unit: N). Pain was measured with a Visual Analogue Scale (VAS), 0-10 (best to worst). Hand functions were evaluated with the patient reported questionnaire Quick Disability Arm Shoulder and Hand (QuickDASH), 0-100 (best to worst).

    Results Mean grip strength (p=0.01) and mean finger extension force (p=0.004) increased after the training period in the group using HE I. In HE II the mean finger extension force increased (p=0.044), table 1. Hand function was stable over the training period.

    Table 1.

    Descriptive data of finger extension (EXIT) force and grip strength in the right hand, hand function (QuickDASH) and VAS pain presented as mean ± SD (min–max)

    Conclusions Five daily minutes with two hand exercises resulted increased grip strength and finger extension force after eight weeks. We suggest that hand exercises should be combined and selected to improve both flexor and extensor muscle strength of the forearm.

  • 4.
    Brorsson, Sofia
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS).
    Nilsdotter, Anna
    Department of Research and Education, Halmstad County Hospital, Halmstad, Sweden.
    Pedersen, Eja
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS).
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Bio- och miljösystemforskning (BLESS).
    Thorstensson, Carina
    Research and Development Centre, Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden.
    Relationship between finger flexion and extension force in healthy women and women with rheumatoid arthritis2012Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, nr 7, s. 605-608Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Balance between flexor and extensor muscle activity is essential for optimal function. The purpose of this pilot study was to compare the relationship between maximum finger flexion force and maximum finger extension force in women with rheumatoid arthritis and healthy women.

    METHODS: Twenty healthy women (median age 61 years) and 20 women with rheumatoid arthritis (median age 59.5 years, median disease duration 16.5 years) were included in the study. Finger extension force was measured with an electronic device, EX-it, and finger flexion force using Grippit. The Grip Ability Test and the score from the patient-reported outcome Disability Arm Shoulder and Hand were used to evaluate activity limitations.

    RESULTS: Patients with rheumatoid arthritis showed significantly decreased hand function compared with healthy controls. A correlation was found between extension force and flexion force in the healthy group (r = 0.65, p = 0.002),but not in the rheumatoid arthritis group (r = 0.25, p = 0.289).

    CONCLUSION: Impaired hand function appears to influence the relationship between maximum finger flexion and extension force. This study showed a difference in the relationship between maximum finger flexion and extension force in healthy controls and those with rheumatoid arthritis. © 2012 Foundation of Rehabilitation Information.

  • 5.
    Eberhardt, K.
    et al.
    Section of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden.
    Forslind, Kristina
    Section of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden.
    Bremander, Ann
    Spenshult, Research And Development Centre, Halmstad, Sweden.
    Svensson, Björn
    Section of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden.
    Andersson, Maria
    Section of Rheumatology, Clinical Sciences, Lund University, Lund, Sweden & Spenshult, Research And Development Centre, Halmstad, Sweden.
    THU0104 Physical Function in Relation to Gender in Patients with Rheumatoid Arthritis – A 15 Year Follow up Study from the Barfot Cohort2015Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 74, s. 230-231Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives The aim was to study physical function in individuals with rheumatoid arthritis (RA) as measured by SOFI (observed physical function) and HAQ (self-rated physical function) over 15 years and describe associated variables, with focus on gender differences.

    Methods In all 2558 patients (847 men and 1711 women) age (SD) 58 (16) were recruited from the BARFOT inception cohort of patients with early RA. They had at inclusion a disease duration of one year or less and fulfilled the ACR 1987 criteria. At 15 years follow-up 663 out of 690 patients participated. Physical function was assessed by the SOFI (Signals of functional impairment) test, (scores 0-44, best to worst) which includes 12 performance tests measuring objective physical function, and the HAQ (Health Assessment Questionnaire) (scores 0-3, best to worst) measuring self-reported activity. A logistic regression model was performed to assess if being in the highest quartile of SOFI and HAQ, respectively, at the15 year follow up visit was associated to gender. Age, disease duration at inclusion, disease activity, smoking habits, RF positivity and pain were included in the model.

    Results Women had lower mean SOFI than men at inclusion and during the first study year, p<0.001. HAQ showed a conversed pattern, where women reported worse physical function than men on all occasions, p<0.001. During the first year SOFI and HAQ decreased in both genders, p<0.001. Thereafter throughout the study period mean SOFI and HAQ increased in men and women, p<0.001, figure 1A and B.

    At the 15 year follow up visit being in the highest quartile of SOFI (score ≥10) was not associated with gender while women had a higher risk to be in the highest quartile of HAQ (score ≥1.13) OR (95% CI) 2.86 (1.73-4.74), p<0.001. DAS 28 at inclusion showed a weak association with SOFI, OR (95% CI) 1.36 (1.11-1.68), p=0.003 while pain at inclusion was somewhat closer associated with HAQ, 1.02 (1.01-1.03), p<0.001. The correlation between the two functional test was r=0.54.

    Conclusions Women had an almost three times higher risk of worse outcome of HAQ after 15 years while the outcome of SOFI was not associated with gender. These two measures provide information of different aspects of physical function and should be used concomitantly.

    Disclosure of Interest None declared

  • 6.
    Emilson, Christina
    et al.
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Demmelmaier, Ingrid
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    Bergman, Stefan
    Research and Development Center Spenshult, Halmstad, Sweden & Department of Public Health, and Community medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lindberg, Per
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Denison, Eva
    School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden.
    Åsenlöf, Pernilla
    Department of Neuroscience, Uppsala University, Uppsala, Sweden.
    A 10-year follow-up of tailored behavioural treatment and exercise-based physiotherapy for persistent musculoskeletal pain2017Inngår i: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 31, nr 2, s. 186-196Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To study the long-term outcomes of two interventions targeting patients with sub-acute and persistent pain in a primary care physiotherapy setting.

    DESIGN: A 10-year follow-up of a two-armed randomised controlled trial, initially including 97 participants.

    INTERVENTIONS: Tailored behavioural medicine treatment, applied in a physiotherapy context (experimental condition), and exercise-based physiotherapy (control condition).

    MAIN MEASURES: Pain-related disability was the primary outcome. The maximum pain intensity, pain control, fear of movement, sickness-related absence (register data) and perceived benefit and confidence in coping with future pain problems were the secondary outcomes.

    RESULTS: Forty-three (44%) participants responded to the follow-up survey, 20 in the tailored behavioural medicine treatment group and 23 in the exercise-based physiotherapy group. The groups did not differ in terms of the change in the scores for the primary outcome (p=0.17) of pain-related disability between the experimental group (median: 2.5, Q1-Q3: -2.5-14.25), and the control group (median: 0, Q1-Q3: -5-6). Further, there were also no significant differences found for the secondary outcomes except for sickness-related absence, where the exercise-based physiotherapy group had more days of sickness-related absence three months before treatment (p= 0.02), and at the 10-year follow-up (p=0.03).

    DISCUSSION: The beneficial effects favouring tailored behavioural medicine treatment that observed post-treatment and at the two-year follow-up were not maintained 10 years after treatment. 

    © The Author(s) 2016

  • 7.
    Haglund, Emma
    et al.
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). RandD Spenshult, Halmstad, Sweden.
    Pinheiro Sant'Anna, Anita
    Högskolan i Halmstad, Akademin för informationsteknologi, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR Centrum för tillämpade intelligenta system (IS-lab).
    Andersson, Maria
    RandD Spenshult, Halmstad, Sweden & Department of Clinical Sciences, Department of Rheumatology, Lund University, Lund,, Sweden.
    Bremander, Ann
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS). Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
    Aili, Katarina
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). RandD Spenshult, Halmstad, Sweden & Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Dynamic joint stability measured as gait symmetry in people with symptomatic knee osteoarthritis2019Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 78, nr Suppl. 2, s. -1458Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Modern strategies for knee osteoarthritis (OA) treatment and prevention includes early detection and analyses about pain, gait and lower extremity muscle function including both strength and stability. The very first sign of knee OA is pain or perceived knee instability, often experienced during weight bearing activities e.g. walking. Increased muscle strength will provide dynamic joint stability, reduce pain, and disability. Specific measures of gait symmetry (GS) can be assessed objectively by using accelerometers, which potentially is a feasible method when evaluating early symptoms of symptomatic knee OA.

    Objectives: The aim was to study if symptoms of early knee pain affected gait symmetry, and the association between lower extremity muscles function and gait symmetry in patients with symptomatic knee OA.

    Methods: Thirty-five participants (mean age 52 SD 9 years, 66% women) with uni- or bilateral symptomatic knee OA, and without signs of an inflammatory rheumatic disease or knee trauma were included. Pain was assessed by a numeric rating scale (NRS, range 0-10 best to worse), tests of lower extremity muscle function with the maximum number of one leg rises. Dynamic stability was measured as GS by using wearable inertial sensors (PXNordic senseneering platform), during the 6 min walking test to obtain spatio-temporal gait parameters. GS was computed based on stride time (temporal symmetry, TS) and stride length (spatial symmetry, SS). Stride length was normalized by height. Kruskal-Wallis and Spearman’s correlation coefficient were used for analyses.

    Results: Reports of knee pain did not differ between gender (women 4.7, SD 2.4 vs. men 3.9, SD 2.4, p= 0.362), neither did one leg rises or gait symmetry. Participants who reported unilateral knee pain (left/right side n=9/13), had a shorter stride length on the painful side. The mean difference in stride length was 0.7% of the subject’s height (SD 1.3). Participants with unilateral pain also presented less SS gait than those who reported bilateral pain (p=0.005). The higher number of one-leg rises performed, the better TS was observed. We found a significant relationship between TS and one-leg rise for the right r s =-0.39, p=0.006, and left r s =-0.40, p=0.004 left side). No significant relationship was observed between SS and one-leg rises.

    Conclusion: Our results is in line with earlier findings stating that knee pain affects GS negatively and that lower extremity muscle function is an important feature for symmetry and dynamic joint stability in patients with symptomatic knee OA. We also found that pain in one leg was related to impaired GS. Bilateral knee pain was however more symmetrical and will need healthy controls for comparison to better understand the negative impact of symptomatic knee OA.

  • 8.
    Johnson, Urban
    et al.
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Parker, James
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Rydberglaboratoriet för tillämpad naturvetenskap (RLAS).
    Ivarsson, Andreas
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Andersen, Mark
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Svetoft, Ingrid
    Högskolan i Halmstad, Akademin för ekonomi, teknik och naturvetenskap, Centrum för innovations-, entreprenörskaps- och lärandeforskning (CIEL).
    Connection in the Fresh Air: A Study on the Benefits of Participation in an Electronic Tracking Outdoor Gym Exercise Programme2019Inngår i: Montenegrin Journal of Sports Science and Medicine, ISSN 1800-8755, E-ISSN 1800-8763, Vol. 8, nr 1, s. 61-67Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    This study aimed to explore whether a six-week intervention, based on participation in outdoor exercise, including activity-tracking devices and combined with individual consulting sessions, can both increase physical activity and yield positive changes in physiological and psychological health measures. A total of six participants, with a mean age of 41.2 (range 33-50 years), completed the ten-week study and the six-week intervention. The full study consisted of a four-week control/baseline and a six-week intervention period in which each participant acted as their own controls. Continuous measures of physical activity data were collected using a wrist-worn activity sensor during the ten-week study, along with pre- and post-measures of cardiovascular fitness, upper-body strength, BMI, general health, and motivation to exercise. The intervention consisted of a resistance-training programme for an outdoor gym and three motivational interviewing sessions. Effect sizes (percentage) for changes pre- to post-training were calculated. The results, because of the small sample size, are presented as individual cases, but the group, as a whole, showed average increases from baseline (pre-) to post-measures in strength (maximum row; 15.33%), time to exhaustion (3.58%), number of steps per day (4%), and autonomous motivation (12%) and average decreases in body weight (-1.08%), fat percentage (-7.58%), strength (chest; -2.5%), and stress symptoms (-2.17%). The six-week intervention programme showed promising results regarding physical activity changes. This study contributes to the limited evidence of the impact of resistance training programmes using outdoor gyms, electronic tracker, and motivational interviewing on physical activity outcomes. © 2019 by the authors.

  • 9.
    Kling, Michaela
    Högskolan i Halmstad, Sektionen för ekonomi och teknik (SET), Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin.
    EFFEKTER AV STABILITETSTRÄNING I FOTLEDEN EFTER SKADA: EN LITTERATURSTUDIE2011Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
  • 10.
    Kristén, Lars
    et al.
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Ring, Mikael
    Unit for Human Geography, Department of Economy and Society. School of Business, Economics and Law, University of Gothenburg, Gothenburg, Sweden.
    SwingPingis ‒ An innovative and norm critical physical activity aid for everyone, everywhere2019Inngår i: European Journal of Adapted Physical Activity, ISSN 1803-3857, E-ISSN 1803-3857, Vol. 12, nr 2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Many children with disabilities face the risk of illness by being excluded from physical education. The purpose of this article is to investigate an open collaborative innovation that can contribute to more inclusive elements in physical education, resulting in a better quality of education for children and youths with a disability. The question asked here is whether performative, bodily, geographical, norm critical and collaborative aspects involved in the use of an innovative aid called Swing Table Tennis (SwingPingis), has any impact on teachers’ perception of inclusion and well-being for the children using the innovation. The methods used in this study are interviews of children with disabilities and their physical education teachers, combined with participant observations carried out during classes using the tool. The findings indicate children and teachers perceive the tool as a means to an embodied, creative part of collaboration and involvement during the lesson, as well as in the teaching of the subject Physical Education. Children perceived SwingPingis as an opportunity to get motor training and build bodily capacities to perform, which in turn were reported as a feeling of the joy in movement. Teachers emphasize SwingPingis usefulness and accessibility. It is an asset in teaching as well as enabling and complementing other motor training in teaching.

  • 11.
    Miyasaka, Hiroyuki
    et al.
    Fujita Health University, Nanakuri Memorial Hospital, Tsu, Japan.
    Takeda, Kotaro
    Faculty of Rehabilitation, School of Healthcare, Fujita Health University, Toyoake, Japan.
    Ohnishi, Hitoshi
    Fujita Health University, Nanakuri Memorial Hospital, Tsu, Japan.
    Orand, Abbas
    Högskolan i Halmstad, Akademin för informationsteknologi, Halmstad Embedded and Intelligent Systems Research (EIS).
    Sonoda, Shigeru
    Fujita Health University, Nanakuri Memorial Hospital, Tsu, Japan & Department of Rehabilitation Medicine II, School of Medicine, Fujita Health University, Tsu, Japan.
    Effect of Sensory Loss on Improvements of Upper-Limb Paralysis Through Robot-Assisted Training: A Preliminary Case Series Study2019Inngår i: Applied Sciences, E-ISSN 2076-3417, Vol. 9, nr 18, artikkel-id 3925Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Sensory disorder is a factor preventing recovery from motor paralysis after stroke. Although several robot-assisted exercises for the hemiplegic upper limb of stroke patients have been proposed, few studies have examined improvement in function in stroke patients with sensory disorder using robot-assisted training. In this study, the efficacies of robot training for the hemiplegic upper limb of three stroke patients with complete sensory loss were compared with those of 19 patients without complete sensory loss. Robot training to assist reach motion was performed in 10 sessions over a 2-week period for 5 days per week at 1 h per day. Before and after the training, the total Fugl–Meyer Assessment score excluding coordination and tendon reflex (FMA-total) and the FMA shoulder and elbow score excluding tendon reflex (FMA-S/E) were evaluated. Reach and patherrors (RE and PE) during the reach motion were also evaluated by the arm-training robot. In most cases, both the FMA-total and the FMA-S/E scores improved. Cases with complete sensory loss showed worse RE and PE scores. Our results suggest that motor paralysis is improved by robot training. However, improvement may be varied according to the presence or absence of somatic sensory feedback. © 2019 MDPI (Basel, Switzerland).

  • 12.
    Orand, Abbas
    et al.
    Högskolan i Halmstad, Akademin för informationsteknologi, Halmstad Embedded and Intelligent Systems Research (EIS).
    Erdal Aksoy, Eren
    Högskolan i Halmstad, Akademin för informationsteknologi, Halmstad Embedded and Intelligent Systems Research (EIS), CAISR Centrum för tillämpade intelligenta system (IS-lab).
    Miyasaka, Hiroyuki
    Department of Rehabilitation, Fujita Health University, Nanakuri Memorial Hospital, Tsu, Japan.
    Weeks Levy, Carolyn
    Schools of Mechatronics Systems Engineering and Engineering Science, Simon Fraser University, Surrey, Canada.
    Zhang, Xin
    Schools of Mechatronics Systems Engineering and Engineering Science, Simon Fraser University, Surrey, Canada.
    Menon, Carlo
    Schools of Mechatronics Systems Engineering and Engineering Science, Simon Fraser University, Surrey, Canada.
    Bilateral Tactile Feedback-Enabled Training for Stroke Survivors Using Microsoft KinectTM2019Inngår i: Sensors, ISSN 1424-8220, E-ISSN 1424-8220, Vol. 19, nr 16, artikkel-id 3474Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Rehabilitation and mobility training of post-stroke patients is crucial for their functional recovery. While traditional methods can still help patients, new rehabilitation and mobility training methods are necessary to facilitate better recovery at lower costs. In this work, our objective was to design and develop a rehabilitation training system targeting the functional recovery ofpost-stroke users with high efficiency. To accomplish this goal, we applied a bilateral training method, which proved to be effective in enhancing motor recovery using tactile feedback for the training. One participant with hemiparesis underwent six weeks of training. Two protocols, “contralater alarm matching” and “both arms moving together”, were carried out by the participant. Each ofthe protocols consisted of “shoulder abduction” and “shoulder flexion” at angles close to 30 and 60 degrees. The participant carried out 15 repetitions at each angle for each task. For example, in the“contralateral arm matching” protocol, the unaffected arm of the participant was set to an angle close to 30 degrees. He was then requested to keep the unaffected arm at the specified angle while trying to match the position with the affected arm. Whenever the two arms matched, a vibration was given on both brachialis muscles. For the “both arms moving together” protocol, the two arms were first set approximately to an angle of either 30 or 60 degrees. The participant was asked to return both arms to a relaxed position before moving both arms back to the remembered specified angle.The arm that was slower in moving to the specified angle received a vibration. We performed clinical assessments before, midway through, and after the training period using a Fugl-Meyer assessment (FMA), a Wolf motor function test (WMFT), and a proprioceptive assessment. For the assessments, two ipsilateral and contralateral arm matching tasks, each consisting of three movements (shoulder abduction, shoulder flexion, and elbow flexion), were used. Movements were performed at two angles, 30 and 60 degrees. For both tasks, the same procedure was used. For example, in the case of the ipsilateral arm matching task, an experimenter positioned the affected arm of the participant at 30 degrees of shoulder abduction. The participant was requested to keep the arm in that positionfor ~5 s before returning to a relaxed initial position. Then, after another ~5-s delay, the participant moved the affected arm back to the remembered position. An experimenter measured this shoulder abduction angle manually using a goniometer. The same procedure was repeated for the 60 degree angle and for the other two movements. We applied a low-cost Kinect to extract the participant’s body joint position data. Tactile feedback was given based on the arm position detected by the Kinect sensor. By using a Kinect sensor, we demonstrated the feasibility of the system for the training ofa post-stroke user. The proposed system can further be employed for self-training of patients at home. The results of the FMA, WMFT, and goniometer angle measurements showed improvements in several tasks, suggesting a positive effect of the training system and its feasibility for further application for stroke survivors’ rehabilitation. © 2019 by the authors.

  • 13.
    Qvarfordt, Maria
    et al.
    Högskolan i Halmstad, Akademin för hälsa och välfärd.
    Andersson, Maria LE
    Section of Rheumatology, Department of Clinical Sciences, Lund University, Lund, Sweden & Spenshult Research and Development Center, Halmstad, Sweden.
    Larsson, Ingrid
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Centrum för forskning om välfärd, hälsa och idrott (CVHI). Spenshult Research and Development Center, Halmstad, Sweden.
    Factors influencing physical activity in patients with early rheumatoid arthritis: A mixed-methods study2019Inngår i: SAGE Open Medicine, E-ISSN 2050-3121, Vol. 7, artikkel-id 2050312119874995Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: The goal of this study was to provide a greater understanding of physical activity in patients with early rheumatoidarthritis. The aim was twofold: first to explore if physical activity was associated with factors in the clinical picture of rheumatoid arthritis in this patient group, and second, to explore factors influencing physical activity in patients with early rheumatoid arthritis.

    Methods: A total of 66 patients with early rheumatoid arthritis were included in the study. A sequential explanatorymixed-methods design was used, where quantitative data from a questionnaire were analysed with Mann–Whitney, post hocKruskal–Wallis and χ2 test in order to detect differences between groups, and find possible associations between physical activity and independent variables, such as disease activity, health-related quality of life and physical function. Qualitative datawere collected in a follow-up questionnaire with open-ended questions that focused on factors influencing physical activity.

    Results: Associations between physical activity, disease activity and health-related quality of life were seen in patients withearly rheumatoid arthritis together with strong negative correlations between physical activity and physical function. Patientson sick leave showed the strongest associations between disease-related variables and lower levels of physical activity.The findings from the qualitative analysis showed that physical limitations, awareness as a motivational factor and external environment factors influenced physical activity in patients with early rheumatoid arthritis.

    Conclusion: The results showed a complex underlying motive where physical, psychological and environmental factors influenced the physical activity in patients with early rheumatoid arthritis. In order to provide more effective health interventions, it is important to consider the complex nature of practicing physical activity, where a person-centred approach should be considered. Factors such as physical limitations, economic aspects and time for practicing physical activity shouldbe included in the person-centred approach.

  • 14.
    Thorstensson, Carina
    Spenshult Hospital for Rheumatic Diseases, Oskarström, Sweden & Lund University, Lund, Sweden.
    Exercise and Functional Performance in Middle-aged Patients with Knee Osteoarthritis2005Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [sv]

    Artros i knäleden är en av de tio vanligaste orsakerna till smärta och funktionshinder hos vuxna. Ett av problemen med artros är att det är svårt att diagnosticera vid ett tidigt stadium. Det kan synas som förändringar på röntgen, men ofta inte förrän flera år efter att det utvecklats. Mina studier visar att det finns ett samband mellan muskelfunktion i benen och risken att senare utveckla artros. Jag har också i olika studier undersökt huruvida träning kan minska belastningen på knäleden, vilka effekter träning kan ha på smärta och funktion hos patienter med dokumenterad artros, samt hur patienterna ser på träning som behandling.

    Artros är en sjukdom som drabbar hela leden, men där effekterna märks främst på ledbrosk och ben. Ledbrosket blir skört och tunnas ut, det bildas bennabbar på ledytans kanter och benvävnaden under ledbrosket förtätas. Ett tidigt och mycket vanligt symptom vid artros är smärta, som leder till svårigheter att belasta leden. En skada av knäleden ökar risken för artros på lång sikt, men även utan tidigare skada är det ungefär 1.5 % av befolkningen som drabbas. Alltför stor belastning på leden medför ökad risk för artrosutveckling. Svaga lårmuskler är vanligt vid knäartros och det har diskuterats om det är en riskfaktor eller en konsekvens av artros. Träning rekommenderas ofta som behandling och har i studier av äldre personer med knäartros visats kunna minska smärtan och förbättra funktionen.

    I min första studie undersöktes muskelfunktion i benen hos ca 150 medelålders personer, som alla hade knäsmärta. Bland annat fick de fick resa sig och sätta sig så många gånger de kunde på ett ben från sittande. Deras knäleder röntgades och ungefär 1/3 hade förändringar som vid artros medan resten var "knäfriska" enligt röntgen. Fem år senare togs nya röntgenbilder och då hade 44 % av de tidigare "knäfriska" utvecklat artros. Jag fann att de som hade sämre förmåga att resa sig på ett ben från sittande i större utsträckning hade utvecklat artros, även om hänsyn togs till övervikt, ålder och kön. Det betyder att nedsatt muskelfunktion i benen ökar risken för att utveckla knäartros.

    I studie två ville jag undersöka om belastning på knäleden kan påverkas med träning. För att bestämma belastningen under rörelse användes tredimensionell rörelseanalys; försökspersonerna rör sig i ett laboratorium med reflexmarkörer fastsatta på huden över speciella landmärken. Speciella kameror registrerar markörerna och ett avancerat datorprogram beräknar belastningen på knäleden. 13 personer med tidiga tecken på artros fick utföra maximalt antal uppresningar på ett ben i laboratoriet och jag mätte ledbelastningen under uppresning före och efter åtta veckors träning. Belastningen på knäleden minskade efter träning och de som klarade flest antal uppresningar hade lägst ledbelastning. Knäsmärta påverkade inte möjligheten att förändra ledbelastningen, men minskade förmågan att förbättra muskelfunktionen. Studien är mycket liten och resultaten får därför tolkas med stor försiktighet.

    Den tredje studien inkluderade drygt 60 personer som alla hade knäsmärta och måttliga till svåra artrosförändringar enligt röntgen. De lottades hälften till 6 veckors intensiv träning och hälften till en kontrollgrupp som levde som vanligt. Jag mätte effekten av träningen med frågeformulär och resultaten visade att träning inte påverkade vare sig smärta eller funktion i träningsgruppen, men att livskvaliteten förbättrades jämfört med kontrollgruppen. Resultatet på individnivå varierade från tydlig förbättring till tydlig försämring.

    För att försöka förstå dessa variationer mellan individer genomförde jag i min fjärde studie intervjuer med hälften av de personer som varit med i träningsgruppen. Jag ville undersöka hur de såg på träning som behandling av artros. Resultaten visade att alla var medvetna om de positiva effekter som träning har på hälsan, men tvivlade på om träning var bra för artros även om de själva hade upplevt förbättring av träning. Att det gjorde ont att träna medförde att de kände sig osäkra på om träning kunde skada leden ytterligare och vissa av dem ville helst inte träna överhuvudtaget. Många ansåg att träning bör introduceras tidigt i sjukdomsförloppet och alla uttryckte att det krävs kontinuerligt stöd och uppmuntran för att fortsätta träna.

  • 15.
    Thorstensson, Carina A.
    et al.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Dept. of Rheumatology, Lund University, Lund, Sweden.
    Roos, Ewa M.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Dept. of Orthopedics, Lund University, Lund, Sweden.
    Petersson, Ingemar F.
    Spenshult Hospital for Rheumatic Diseases, Halmstad, Sweden & Dept. of Orthopedics, Lund University, Lund, Sweden.
    Ekdahl, Charlotte
    Dept. of Physical Therapy, Lund University, Lund, Sweden.
    Six-week high-intensity exercise program for middle-aged patients with knee osteoarthritis: a randomized controlled trial [ISRCTN20244858]2005Inngår i: BMC Musculoskeletal Disorders, ISSN 1471-2474, E-ISSN 1471-2474, Vol. 6, artikkel-id 27Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Studies on exercise in knee osteoarthritis (OA) have focused on elderly subjects. Subjects in this study were middle-aged with symptomatic and definite radiographic knee osteoarthritis. The aim was to test the effects of a short-term, high-intensity exercise program on self-reported pain, function and quality of life. Methods: Patients aged 36-65, with OA grade III (Kellgren & Lawrence) were recruited. They had been referred for radiographic examination due to knee pain and had no history of major knee injury. They were randomized to a twice weekly supervised one hour exercise intervention for six weeks, or to a non-intervention control group. Exercise was performed at ≥ 60% of maximum heart rate (HR max). The primary outcome measure was the Knee injury and Osteoarthritis Outcome Score (KOOS). Follow-up occurred at 6 weeks and 6 months. Results: Sixty-one subjects (mean age 56 (SD 6), 51 % women, mean BMI 29.5 (SD 4.8)) were randomly assigned to intervention (n = 30) or control group (n = 31). No significant differences in the KOOS subscales assessing pain, other symptoms, or function in daily life or in sport and recreation were seen at any time point between exercisers and controls. In the exercise group, an improvement was seen at 6 weeks in the KOOS subscale quality of life compared to the control group (mean change 4.0 vs. -0.7, p = 0.05). The difference between groups was still persistent at 6 months (p = 0.02). Conclusion: A six-week high-intensive exercise program had no effect on pain or function in middle-aged patients with moderate to severe radiographic knee OA. Some effect was seen on quality of life in the exercise group compared to the control group. © 2005 Thorstensson et al; licensee BioMed Central Ltd.

  • 16.
    Wikander, Robert
    et al.
    Högskolan i Halmstad, Sektionen för ekonomi och teknik (SET), Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin.
    Augustsson, Johan
    Högskolan i Halmstad, Sektionen för ekonomi och teknik (SET), Bio- och miljösystemforskning (BLESS), Biomekanik och biomedicin.
    Kan ett nyutvecklat handledsstöd förbättra möjligheterna för funktionell träning av övre extremiteten för reumatiker?: En SEMG-studie2011Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
    Abstract [sv]

    I en generell rehabiliteringsfas så är styrketräning en viktig del på grund av att muskelsvaghet kan bidra till nedsatt funktion och det leder till avvikande rörelsemönster. Begränsad range of motion (ROM) i övre extremiteten är en bidragande faktor till att individer inte kan utföra vardagliga aktiviteter. Flera studier har dokumenterat att patienter med reumatoid artrit (RA) har försämrad handfunktion på grund av nedsatt greppstyrka och inskränkningar i ROM.

    Funktionell träning är till för att stärka upp de svaga musklerna som orsakar obalansen eller smärtan samtidigt som kroppen blir rörligare. Genom att använda sig av vardagliga rörelser och implementera dem med träningen så görs träningen mer funktionell. Syftet med studien var att utveckla och utvärdera ett nytt handledsstöd för att öka möjligheterna till funktionell träning av övre extremiteterna för reumatiker.

    I studien deltog 27 kvinnor varav 8 stycken med diagnosen RA och 19 stycken friska. Medelåldern var 38år (20-73år). Muskelaktiviteten i m. trapezius och m. rhomboideus mättes med hjälp av ytelektromyografi (sEMG) under tre övningar för att jämföra skillnaderna mellan både RA och friska, samt med och utan framtagen produkt.

    Resultaten visade att det går att träna övre extremiteten utan behöva använda handens greppstyrka. Det var ingen signifikant skillnad i muskelaktivitet i m. trapezius och m. rhomboideus med eller utan produkt. Resultaten visade även att reumatisk muskulatur inte skiljer sig från frisk. Deltagarnas subjektiva uppfattning var mycket positiv där 24 av 27 deltagare upplevde det som enklare att genomföra övningen med produkten och 9 av 27 upplevde det enklare att fokusera på övningen.

    Studien har resulterat i ett nytt handledsstöd som möjliggör funktionell träning av m.trapezius och m.rhomboideus för reumatiker.

  • 17.
    Zarzoura, Mohamed
    et al.
    Mechatronics Department, Faculty of Engineering, Ain Shams University, Cairo, Egypt.
    Del Moral, Pablo
    Högskolan i Halmstad, Akademin för informationsteknologi.
    Awad, Mohammed I.
    Mechatronics Department, Faculty of Engineering, Ain Shams University, Cairo, Egypt.
    Tolbah, Farid A.
    Mechatronics Department, Faculty of Engineering, Ain Shams University, Cairo, Egypt.
    Investigation into reducing anthropomorphic hand degrees of freedom while maintaining human hand grasping functions2019Inngår i: Proceedings of the Institution of mechanical engineers. Part H, journal of engineering in medicine, ISSN 0954-4119, E-ISSN 2041-3033, Vol. 233, nr 2, s. 279-292Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Underactuation is widely used when designing anthropomorphic hand, which involves fewer degrees of actuation than degrees of freedom. However, the similarities between coordinated joint movements and movement variances across different grasp tasks have not been suitably examined. This work suggests a systematic approach to identify the actuation strategy with the minimum number for degrees of actuation for anthropomorphic hands. This work evaluates the correlations of coordinated movements in human hands during 23 grasp tasks to suggest actuation strategies for anthropomorphic hands. Our approach proceeds as follows: first, we find the best description for each coordinated joint movement in each grasp task by using multiple linear regression; then, based on the similarities between joint movements, we classify hand joints into groups by using hierarchical cluster analysis; finally, we reduce the dimensionality of each group of joints by employing principal components analysis. The metacarpophalangeal joints and proximal interphalangeal joints have the best and most consistent description of their coordinated movements across all grasp tasks. The thumb metacarpophalangeal and abduction/adduction between the ring and little fingers exhibit relatively high independence of movement. The distal interphalangeal joints show a high degree of independent movement but not for all grasp tasks. Analysis of the results indicates that for the distal interphalangeal joints, their coordinated movements are better explained when all fingers wrap around the object. Our approach fails to provide more information for the other joints. We conclude that 19 degrees of freedom for an anthropomorphic hand can be reduced to 13 degrees of actuation distributed between six groups of joints. The number of degrees of actuation can be further reduced to six by relaxing the dimensionality reduction criteria. Other resolutions are as follows: (a) the joint coupling scheme should be joint-based rather than finger-based and (b) hand designs may need to include finger abduction/adduction movements.

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