Axel R. Fugl-Meyer

Happiness and domain-specific life satisfaction in adult northern Swedes

Levels of satisfaction with life as a whole (happiness) and with eight different domains were investigated using mailed questionnaires in four age cohorts (25-, 35-, 45- and 55-year-olds) of men and women. With a few exceptions (vocational and financial satisfaction) levels of global and domain-specific satisfaction were not age-dependent and few gender differences were found. The generally high levels of satisfaction correspond well to those found in the USA and in Germany. Satisfaction with expressive (emotion-related) domains was greater in women than in men, and the provider items - satisfaction with vocational and financial situation -were influenced by age. The eight domains formed three meaningful factors: the first characterized satisfaction derived from expressive goals; the second from spare-time goals; and the third factor was instrumental (performance-related), characterizing satisfaction derived from provider goals. The three factors predicted gross level of happiness (happy/not happy) for 82% of subjects with complete answers, all three factors being significant predictors.

Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground:

Objective: To compare the effect of walking training on a treadmill with body weight support (BWS) and walking training on the ground at an early stage of rehabilitation in patients with hemiparesis after stroke. Design: Randomized controlled experimental study. Setting: Multicentre design; three departments of rehabilitation medicine. Subjects: Seventy-three consecutive first stroke patients admitted to a rehabilitation clinic were randomized into a treatment group and a control group. Interventions: The treatment group received walking training on a treadmill with BWS for 30 minutes, 5 days a week. The control group received walking training according to the Motor Relearning Programme (MRP) on the ground for 30 minutes 5 days a week, not including treadmill training. During the time in the rehabilitation department (about two months), all patients in the study also received professional stroke rehabilitation besides the walking training in the two groups. Main outcome measures: Functional Independence Measure (FIM), walking velocity for 10 m, Functional Ambulation Classification (FAC), Fugl-Meyer Stroke Assessment and Bergs Balance Scale. The assessments were performed at admission, at discharge and at 10-month follow-up. Results: There were no statistically significant differences between the groups at discharge or at the 10-month follow-up with regard to FIM, walking velocity, FAC, Fugl-Meyer Stroke Assessment, and Bergs Balance Scale. Patients in both groups improved in these variables from admission to the 10-month follow-up. Conclusions: Treadmill training with BWS at an early stage of rehabilitation after stroke is a comparable choice to walking training on the ground.

Self-efficacy in relation to impairments and activities of daily living disability in elderly patients with stroke: a prospective investigation

OBJECTIVES The objectives of this prospective study, undertaken in elderly patients with stroke undergoing rehabilitation, were to determine to what extent fall-related self-efficacy changes over time, its relationships to objectively assessed functions and activities, and the predictive capacity of self-efficacy at discharge for activities of daily living 10 months after stroke. METHODS The study comprised 37 patients, aged 66-89 years. Main outcome measurement instruments were the Falls Efficacy Scale (Swedish version), Berg Balance Scale and Functional Independence Measure. RESULTS Significant improvements occurred in all these measures from admission to discharge, but patients with low self-efficacy at discharge showed less pronounced improvements than those with high self-efficacy. Falls Efficacy Scale (Swedish version) was closely associated with all other measures and was a more powerful predictor of activities of daily living than the observer-based measures of balance. CONCLUSION To minimize dependence in activities of daily living, rehabilitation interventions should incorporate self-efficacy enhancement.

Life satisfaction in 18- to 64-year-old Swedes: In relation to education, employment situation, health and physical activity.

OBJECTIVE The aim of this study is to relate different sociodemographic, health and physical activity parameters to levels of satisfaction with life as a whole and with 10 specific domains of life. DESIGN Data on socio-demographic items were sampled, using strictly structured interviews, while a checklist (LiSat-11) was used for self-reported levels of life satisfaction. SUBJECTS A nationally representative Swedish sample of 1207 women and 1326 men aged 18-64 years. RESULTS Univariately most of these socio-demographic variables were associated with several of the LiSat-11 items. Using logistic regression, perceived good health and not being a first generation immigrant were the most prominent positive predictors of satisfaction with life as a whole and of most of the domains. Also educational level impacted predictively on satisfaction with many LiSat-11 items. Furthermore, those who were vocationally active, perceived their financial situation as better than or similar to most peoples and had a steady partner relationship were particularly likely to be satisfied with life as a whole and with two or more of the domains. CONCLUSION These results indicate that a multitude of aspects must be taken into account when assessing life satisfaction.

On categorization and quantification of women's sexual dysfunctions: An epidemiological approach

The objectives of this study are to compare the two definitions of female sexual dysfunction, namely dysfunction per se (A category) and personal distress caused by dysfunction (B category), and to gauge their associations with some sociodemographic aspects and level of sexual well-being. The subjects were a nationally representative sample of sexually active Swedish women (n: 1056) aged 18–65 y, who participated in a combined structured interview/questionnaire investigation. The functions analysed were: self-reported sexual desire, interest, lubrication, orgasm, genital pain and vaginism, which were subclassified for the A and B categories into no, mild (sporadically occurring) and manifest dysfunction. Sexual well-being was reported along a six-grade scale ranging from very satisfied to very dissatisfied. The sociodemographic items registered were: education, occupation, financial situation, social group, immigrant status, location of domicile and church-going. Aggregated mild and manifest dysfunction per se of sexual interest, orgasm and vaginal lubrication were reported by about 60–90%. More than one-third had dyspareunia, but few reported vaginism. Mild dysfunctions were clearly more common than manifest dysfunctions. Not fully 45% of those with manifest low interest and orgasm perceived these dysfunctions as manifestly distressing, while in 60–70% lubricational insufficiency of dyspareunia led to manifest distress. Age and the included sociodemographic variables had marginal or no influence on sexual functions. A four-factor sexual function pattern was identified, closely linking A and B categories in a pairwise manner. Three factors, labelled sexual desire, orgasm and genital function were powerful classifiers (discriminant analysis) of level of sexual well-being. Hence, it is a matter of taste whether to use the A or the B category. Together, they can explain the gross level of satisfaction with sexual life to an adequate extent.

Thigh musculature in relation to chronic anterior cruciate ligament tear: Muscle size, morphology, and mechanical output before reconstruction

Eighteen male patients who had untreated chronic ACL rupture were studied in order to evaluate thigh muscle size, morphology, and isokinetic performance of the quadriceps muscle. Computed tomography disclosed a 5.1 % mean atrophy of the quadriceps (P < 0.05), 2.1% slight hypertrophy of the hamstrings (P > 0.05), and also nonsignificant changes of all other muscle areas of the injured thigh. Muscle morphology (m. vastus lateralis) was normal in 11 biopsy specimens, whereas minor abnormalities (irregular shape or hypotrophy) could be seen in the rest. Isokinetic mechanical output of the knee extensors was 71% to 87% of that of the noninjured limb (P < 0.01), and the mechanical output corrected for differences in quadriceps cross-sectional area was significantly lower in the injured than the uninjured limb. As there were no significant correlations between isokinetic performance and muscle size or qualitative morphology or morphometric data, the strength decrease cannot be explained by muscle atro phy or structural changes per se. We conclude that nonoptimal activation of the muscles during voluntary contractions is probably the most important causative mechanism of the strength decrease found in patients who have chronic symptomatic ACL tear.

Isokinetic and static plantar flexion characteristics

SummaryIsokinetic and static maximum plantar flexion torques were measured in 135 adults with sedentary professions. Close associations between isokinetic and static peak torques were found. Between the ages 20–49 years strength did not differ. Thereafter strength declined as a function of age. Maximum strength was 35% lower in females than in males. The right plantar flexion strength was slightly lower than the left. Maximum plantar flexion strength was about 15% lower with flexed than with extended knees. A negative exponential model characterized the decline of strength as a function of increased isokinetic velocity of angular motion. Seventy per cent or more of the variations in maximum static and isokinetic strength could be explained by anthropometric variables and by age, and by the extent of physical activity in subjects younger than 50 years. Formulas for estimation of expected static and isokinetic strengths are given.

Motor and perceptual impairments in acute stroke patients: effects on self-care ability.

The relative importance of motor, perceptual, and some cognitive functions for self-care ability was analyzed in a representative sample of 109 subjects within 2 weeks of acute stroke. Forty-nine patients (45%) were dependent or partly dependent in self-care. Profound motor dysfunction was present in 39%, low-order perceptual deficits in 10%, high-order perceptual deficits in 60%, and disorientation in time and space in 13% of the patients. There was a significant covariation between motor function and self-care ability and between low-order perception and orientation function. Low-order and high-order perception covaried only weakly. Discriminant analyses showed that the actual level of self-care proficiency could be correctly predicted in 70% of the cases by the 4 indexes of motor function, low-order perception, high-order perception, and orientation. The dominating predictor was motor function, and the next highest was high-order perception. When a program for early training is designed with the aim to alleviate long-term self-care disability after stroke, correct assessment of motor and perceptual functions in the individual stroke patient is essential.

Does a torn anterior cruciate ligament lead to change in the central nervous drive of the knee extensors

SummaryIntegrated surface electromyograms of the three superficial parts of the quadriceps and isokinetic knee extensor maximum torque and power production were recorded simultaneously and at different angular velocities in both legs in 11 male subjects with unilateral tear of the anterior cruciate ligament. The cross-sectional area (CSA) of the thigh and its muscular components were measured by computerized tomography. The principal findings were a small but significant decrease in quadriceps CSA on the affected side; a decreased active, but not passive, range of movement; decreased mechanical output, whether or not corrected for differences in CSA; and decreased electrornyographic activity — particularly in rectus femoris. These findings suggest that the reason for the decreased maximum and total knee extensor performance seen in these patients is a change in knee joint receptor afferent inflow.

Adjustment to life after stroke with special reference to sexual intercourse and leisure

Changes in frequency of sexual intercourse and of leisure activities were related to degree of physical impairment and levels of dependence in primary and secondary ADL in 110 subjects with one stroke. About 75% of the subjects reduced their frequency or ceased having intercourse and active leisure. While changes in frequency of intercourse were temporally independent, changes in leisure activities were less pronounced for subjects examined later than 12 months after the stroke than for those investigated earlier. For intercourse, primarily ADL-dependence and impaired cutaneous sensibility were major negative determinants. Moreover, subjects with previously known arterial hypertension, myocardial infarction or diabetes mellitus had changed relatively less than those without these ailments, probably due to pre-stroke reductions. It is suggested that the marked changes in sexual and leisure activities are accomplished by unsuccessful coping with the vascular catastrophe and its sequelae. Aspects of coping problems, primarily the disease-related, but also those of intra- and inter-personal nature are discussed.