Kersti Samuelsson

Computerized training of working memory in a group of patients suffering from acquired brain injury

Objective: Study short- and long-term transfer effects of a computerized working memory (WM) training programme for patients suffering from working memory deficits after acquired brain injury. Research design: A controlled experimental study with a cross-over design. Methods: A consecutive sample of 21 subjects. Mean age 43.2 years, time since injury/illness onset 37 months (median). The subjects were randomly selected into two groups where one group served as controls. All subjects trained daily for 5 weeks in a computer WM task program. They were followed-up at 4 and 20 weeks after the training. Results: A significant improvement in the trained WM tasks, significant improvements in neuropsychological WM-test results at 4 and 20 weeks after training compared to baseline. Improvement in the subjects’ rated occupational performance and satisfaction with performance in pre-defined occupational problems. Rated quality-of-life did not change. However, rated overall health increased 20 weeks after training. Conclusions: Structured and intense computerized WM training improves subjects’ cognitive functioning as measured by neuropsychological WM-demanding tests, rated occupational performance, satisfaction with performance and rated overall health. The training probably has an impact on the rehabilitation outcome, returning to work, as well as on daily activities for individuals with verified WM impairments.

Shoulder pain and its consequences in paraplegic spinal cord-injured, wheelchair users

Study design: Cross-sectional.Objectives: To describe the consequences of shoulder pain on activity and participation in spinal cord-injured paraplegic wheelchair users. To describe the prevalence and type of shoulder pain.Setting: Two spinal cord injury (SCI) centres in Sweden.Methods: All subjects with paraplegia due to an SCI of more than 1 year living in the counties of Uppsala and Linköping, Sweden were contacted by mail and asked to fill in a questionnaire (89 subjects). Those of the responding 56 subjects with current shoulder pain were asked to participate in further examination and interviews. A physiotherapist examined 13 subjects with shoulder pain in order to describe type and site of impairment. To describe consequences of shoulder pain on activity and participation, the Constant Murley Scale (CMS), the Wheelchair Users Shoulder Pain Index (WUSPI) the Klein & Bell adl-index and the Canadian Occupational Performance Measure (COPM) were used.Results: Out of all respondents, 21 had shoulder pain (37.5%). Data from 13 of those subjects were used in the description of type and consequences of shoulder pain. Findings of muscular atrophy, pain, impingement and tendinits were described. We found no difference in ADL-performance with, respectively without, shoulder pain (P=0.08) using the Klein & Bell adl-index. No correlation was found between the various descriptions of impairment, activity limitations and participation restriction (P>0.08). All together 52 problems with occupational performance due to shoulder pain were identified using the COPM. Of these, 54% were related to self-care activities.Conclusion: The consequences of shoulder pain in paraplegic wheelchair users are mostly related to wheelchair activities. Since the wheelchair use itself presumably cause shoulder problems, this will become a vicious circle. More research is needed in order to reduce shoulder problems in wheelchair users.

Responsiveness of the Swedish Version of the Canadian Occupational Performance Measure

In a client-centred approach, clients and therapists work together to define the occupational performance problem, the focus of and need for intervention and the preferred outcomes. Application of specific theories or techniques to involve clients in goal-setting may influence the therapist to use a client participation approach. The Canadian Occupational Performance Measure (COPM) presents a structure for formulating the treatment goals identified by the client in co-operation with the therapist. The aim of this study was to test the responsiveness of the Swedish version of the COPM. After translation into Swedish, the COPM was introduced to 21 occupational therapists who performed data collection. A sample of 108 clients within geriatric, neurologic and orthopaedic rehabilitation identified 418 problems at initial scoring and reassessment. Inclusion criteria for patients were the need for rehabilitation interventions and the ability to communicate well enough in an interview. The results indicate that t...

User satisfaction with mobility assistive devices: An important element in the rehabilitation process

Background. An assistive device often means an evident change in a persons ability, more easy to notice than the effects of most of other types of physiotherapy or occupational therapy intervention. In spite of this, there is very little evidence in this area. Purpose. The objective was to follow-up user satisfaction with and the use and usefulness of rollators and manual wheelchairs. The objective was also to determine any difference in satisfaction between users of the two different types of mobility assistive products. Methods. A random sample of 262 users participated in the study, 175 rollator users and 87 wheelchair users. The Quebec User Evaluation of Satisfaction with Assistive Technology—QUEST 2.0 and an additional questionnaire were used for data collection. Results. Overall satisfaction with both types of device was high and most clients reported use of their device on a daily basis. There was a difference in how the users estimated the usefulness and other characteristics as well as some service aspects related to prescription and use of the two types of device. Most users reported not having had any follow-up; however, most users had not experienced any need for one. Conclusions. A standardized follow-up will give rehabilitation professionals continuous and valuable information about the effect of and satisfaction with assistive devices.

User Satisfaction with Mobility Assistive Devices

In Sweden, the most common assistive devices are related to mobility. A study was undertaken to evaluate users’ opinions on prescription of mobility devices and their satisfaction with devices and services using a cross-sectional design. A random sample of adult users of mobility assistive devices living in three county councils of Sweden was selected. A postal package comprising a questionnaire and QUEST 2.0 was sent out to 400 users of manual wheelchairs, powered wheelchairs, or walkers. Included in the analysis were 208 questionnaires, a response rate of 52%. Most devices were used on a daily basis and satisfaction with the device was high. Satisfaction with the service was scored lower than satisfaction with the device. Follow-up was the single item with the lowest mean score, and 69% of the users reported that they had not received any follow-up. A positive effect especially on users’ ability to be active, transport oneself, feel secure, and to take part in social activities was found. Owing to the low response rate the results have to be interpreted with caution. However, follow-up seems to be an area that needs to be improved. The majority of users are satisfied with the device but not with service.

The effect of rear-wheel position on seating ergonomics and mobility efficiency in wheelchair users with spinal cord injuries : A pilot study

This study analyzed the effect of rear-wheel position on seating comfort and mobility efficiency. Twelve randomly selected paraplegic wheelchair users participated in the study. Wheelchairs were tested in two rear-wheel positions while the users operated the wheelchair on a treadmill and while they worked on a computer. Propulsion efficiency, seating comfort, and propulsion qualities were registered at different loads during the treadmill session. During the computer session, pelvic position, estimated seating comfort, and estimated activity performance were measured. The change in rear-wheel position affected wheelchair ergonomics with respect to weight distribution (p < 0.0001) and seat inclination angle (position I = 5 and position II = 12). These changes had a significant effect on push frequency (p < 0.05) and stroke angle (p < 0.05) during wheelchair propulsion. We found no consistent effect on mechanical efficiency, estimated exertion, breathlessness, seating comfort, estimated propulsion qualities, pelvic position, or activity performance.

Improved self-awareness and coping strategies for patients with acquired brain injury—A group therapy programme

Primary objective: This study evaluates the effects of a group therapy programme for anticipatory self-awareness and coping strategies. Design: The study includes methodological triangulation using three methods to gather data: an overall self-report questionnaire, Self Regulation Skills Interview (SRSI) and focus group interview. Subjects: Twenty-one individuals with acquired brain injury participated in a group therapy programme. Methods: A self-report questionnaire developed and used especially for evaluation of the described intervention was used at the end of the last session of the group therapy programme. The Self Regulation Skills Interview–SRSI, was used within 2 weeks before and after the subjects participated in one group program. Three Focus groups were used as a third method for data collection. The Focus group interviews were accomplished 1 month after each group programme. Results: The individuals increased their self-awareness and strategy behaviour significantly. Participating in the group therapy programme had had an effect on their life and work situation and on their self-confidence. Conclusions: A structured group therapy programme helps patients with acquired brain injury understand the consequences of their neuropsychological deficits, helps them improve awareness of their impairments and helps them develop coping strategies.

Wheelchair seating intervention. Results from a client-centred approach

Purpose : The aim of this study was to analyse the effects of wheelchair intervention from a client-centred perspective. Method : Results from 38 consecutive active wheelchair users visiting the wheelchair-seating department at the University Hospital in Linköping, Sweden, were analysed and described. All clients had defined problems related to wheelchair seating. Back pain was estimated before intervention and at follow-up, using a Visual Analogue Scale. The effect of intervention on different aspects of wheelchair functionality, seating and occupational performance was estimated by the clients at follow-up. Results : Two initial main problem areas were identified among the group; seating discomfort (87% ) and back pain (63% ). Back pain was significantly reduced at follow-up (p<0.001). Problems initially defined by the clients, e.g. seating discomfort, were affected positively, in 79% of all clients, as estimated by the clients at follow-up. No significant correlation was found between the initial cause of intervention or the highest ranked wheelchair functionality aspect and final acceptance of intervention. Conclusions : The results from this study confirm the possibility of reducing, or even eliminating, common secondary problems such as back pain and discomfort, related to wheelchair seating by individually adjusted measures. Further research and development in this field is both necessary and cost-effective.

Power output for wheelchair driving on a treadmill compared with arm crank ergometry.

OBJECTIVES: The limiting factors with regard to power output available for wheelchair ambulation have not been identified. The aim of the present study was to correlate power output during wheelchair driving with (i) power output and oxygen uptake during arm crank ergometry and (ii) arm muscle strength. METHODS: Eleven disabled men were examined for maximal power output (POmax) during wheelchair driving on a treadmill and during arm crank ergometry. Oxygen uptake (VO2) was recorded at submaximal and maximal arm crank ergometry in all men and during submaximal wheelchair driving on a treadmill in four men. Power output during wheelchair driving on a treadmill was measured. Static and dynamic elbow muscle strength was measured isokinetically. RESULTS: POmax was significantly lower (P < 0.001) for wheelchair driving (109 (31) W; mean (SD)) than for arm ergometry (163 (49) W). There was a significant correlation between POmax for arm crank ergometry and wheelchair driving (r = 0.73). There was no correlation between POmax and elbow strength. The mechanical efficiency was constant for the different levels on the arm crank ergometry test. The submaximal testing showed a consistently lower mechanical efficiency for wheelchair driving than for arm crank ergometry. CONCLUSIONS: It is suggested that the lower level of power output for wheelchair driving is fully explained by the lower mechanical efficiency. Any improvement in power output available for ambulation must be based on wheelchair ergonomics.

Evaluation of manual wheelchairs by individuals with spinal cord injuries

Purpose. The aim of this study was to investigate how adults with spinal cord injury assess their satisfaction regarding various aspects and use of their manual wheelchair. Method. The Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST 2.0) together with seven additional questions was sent to 205 adults with SCI. Results. One hundred and twenty-four responses were available. The QUEST 2.0 showed a high level of satisfaction with manual wheelchair properties. However, the respondents were less satisfied with the services offered. Ease of use and comfort were identified as most important. Eighty-nine percent of the respondents rated their level of satisfaction as ‘quite satisfied’ or ‘very satisfied’ in ease of using a manual wheelchair compared with 68% of the respondents that were ‘quite satisfied’ or ‘very satisfied’ with the level of comfort. A greater satisfaction of ease in propulsion indoors compared with sitting comfort in various activities was found. Conclusions. A discrepancy was shown between users not being as satisfied with comfort in sitting in various activities as opposed to satisfaction with propulsion. This indicates the need for increased knowledge and developments concerning individual solutions, incorporating comfort as well as ease of use of a manual wheelchair.