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  • 1.
    Augutis, M
    et al.
    Department of Public Health and Research, Sundsvall Hospital, Sundsvall, Sweden.
    Abel, R
    Orthopädische Universitätsklinik, Heidelberg-Schlierbach, Germany.
    Levi, Richard
    Karolinska Institute and Rehab Station Stockholm, Sweden.
    Pediatric spinal cord injury in a subset of European countries.2006In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 44, no 2, 106-112 p.Article in journal (Refereed)
    Abstract [en]

    Study design:Postal survey.Setting:A total of 19 countries in Europe.Objectives:Firstly, to collect information about incidence and systems of care for pediatric spinal cord injury (pedSCI); including prevention, initial care and follow-up in a subset of European countries. Secondly, to initiate a network of involved professionals for exchange of information and development of research and care programs.Methods:A short semi-structured questionnaire was sent to respondents working with spinal cord injury (SCI) in 19 countries in Europe.Results:Only in Portugal and Sweden, is the incidence of pedSCI (fatal injuries included) established, that is 27 children/million children/year and 4.6 children/million children/year, respectively. For the other countries, the estimated incidence of pedSCI (nonfatal injuries) varied from 0.9 to 21.2 children/million children/year in the age group of 0–14 years. Although the incidence varies considerably, pedSCI is rare throughout Europe. The management differs between the countries depending on the age of the child and the local organization of health care.Conclusions:The survey confirms that pedSCI is rare. In order to establish high-quality standardized care, further integration of knowledge in this area is needed throughout Europe. The contacts initiated by this survey may be used to create an international network serving as a reference for health professionals, researchers and families, thereby possibly alleviating some of the unwanted variations of care identified in this study.Spinal Cord (2006) 44, 106–112. doi:andlt;highlightandgt;10.1038andlt;/highlightandgt;/andlt;highlightandgt;sj.scandlt;/highlightandgt;.andlt;highlightandgt;3101793andlt;/highlightandgt;; published online 30 August 2005 [ABSTRACT FROM AUTHOR]

  • 2.
    Augutis, M
    et al.
    FoU, Sundsvall Hospital, Sundsvall, Sweden.
    Levi, Richard
    Rehab Station Stockholm and Karolinska Institute, Stockholm, Sweden.
    Pediatric spinal cord injury in Sweden: incidence, etiology and outcome.2003In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 41, no 6, 328-336 p.Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN:: Retrospective descriptive study. OBJECTIVES:: To assess incidence, causes and early outcome of traumatic spinal cord injury (SCI) among children in Sweden, thereby identifying high-risk groups and situations as a basis for preventative measures and improved care. METHODS:: Data from population registers, County Habilitation Centers as well as from informal sources were used to estimate the incidence of SCI in Sweden during the years 1985-1996 among children aged 0-15 years. Contacts with the treating hospitals, reviews of medical records and/or personal interviews were used to verify primary data. In total, 92 children were thus identified. RESULTS:: The incidence was found to be 4.6/million children/year (95% CI 3.6-5.5). When excluding prehospital fatalities, the incidence was 2.4 (95% CI 1.8-3.1). The main cause of injury among fatalities was traffic accidents. Associated injuries occurred in 41% of the children. Among survivors (10-15 years), sports-related injuries (43%) were as common a cause as traffic accidents (39%). The survivors were treated in 18 different hospitals. CONCLUSION:: Pediatric SCI in Sweden is rare, presumably because of effective primary prevention. Preventative measures should be further differentiated for each age group of children in accordance with their differing risk profiles. In contrast to the effective preventative measures that have been implemented in Sweden, care of these patients is still too fractionated and decentralized for sufficient specialization to emerge.Spinal Cord (2003) 41, 328-336. doi:andlt;highlightandgt;10.1038andlt;/highlightandgt;/andlt;highlightandgt;sj.scandlt;/highlightandgt;.andlt;highlightandgt;3101478andlt;/highlightandgt; [ABSTRACT FROM AUTHOR]

  • 3.
    Augutis, M
    et al.
    FoU, Sundsvall Hospital, Sundsvall, Sweden.
    Malker, H
    Mid Sweden Research and Development Center, Vasternorrland County Council, Sundsvall, Sweden.
    Levi, Richard
    Karolinska Institute and Frosunda Center, Stockholm, Sweden.
    Pediatric spinal cord injury in Sweden; how to identify a cohort of rare events.2003In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 41, no 6, 337-346 p.Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN:: Register study enhanced and verified by medical records and personal interviews and examinations. SETTINGS:: Sweden. OBJECTIVES:: To define a method of identifying a study population of rare events. To point out the relative importance of every step, an example is given of identifying persons who sustained traumatic spinal cord injury (SCI) in childhood. METHODS:: Cases were identified in seven steps that all needed to be fulfilled, from definition of selection criteria through combination of several data sources, to the use of several verification methods. RESULTS:: Initial screening by registers identified 384 possible cases, which however were found by subsequent analysis to include a large number of incorrect cases. At completion of all analytic steps, 35 living cases could be fully verified and 14 deceased cases could be partially verified. CONCLUSIONS:: Registers offer a practical initial source for study population identification. The screening of International Classification of Diseases codes defining SCI only included less than 30% of true SCIs. Subsequently, further refinement and quality control is necessary in order to ensure validity. Such further verification is time-consuming, but nevertheless necessary in order to verify a true cohort.Spinal Cord (2003) 41, 337-346. doi:andlt;highlightandgt;10.1038andlt;/highlightandgt;/andlt;highlightandgt;sj.scandlt;/highlightandgt;.andlt;highlightandgt;3101456andlt;/highlightandgt; [ABSTRACT FROM AUTHOR]

  • 4.
    Augutis, Marika
    et al.
    Karolinska Institute, Sweden.
    Levi, Richard
    Karolinska Institute, Sweden.
    Asplund, Kenneth
    Mid-Sweden University, Sundsvall, Sweden.
    Berg-Kelly, Kristina
    Karolinska Institute, Sweden.
    Psychosocial aspects of traumatic spinal cord injury with onset during adolescence: a qualitative study.2007In: Journal of Spinal Cord Medicine (JSCM), ISSN 1079-0268, E-ISSN 2045-7723, Vol. 30 Suppl 1, S55-S64 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVE: Spinal cord injury (SCI) occurring during adolescence poses additional challenges because of the concurrent age

  • 5.
    Awad, A
    et al.
    Umeå Center for Functional Brain Imaging (UFBI), Umeå, Sweden..
    Levi, Richard
    Umeå Center for Functional Brain Imaging (UFBI), Umeå, Sweden..
    Lindgren, L
    Umeå Center for Functional Brain Imaging (UFBI), Umeå, Sweden..
    Hultling, C
    Umeå Center for Functional Brain Imaging (UFBI), Umeå, Sweden..
    Westling, G
    Umeå Center for Functional Brain Imaging (UFBI), Umeå, Sweden..
    Nyberg, L
    Umeå Center for Functional Brain Imaging (UFBI), Umeå, Sweden..
    Eriksson, J
    Umeå Center for Functional Brain Imaging (UFBI), Umeå, Sweden..
    Preserved somatosensory conduction in a patient with complete cervical spinal cord injury.2015In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 47, no 5, 426-431 p.Article in journal (Refereed)
    Abstract [en]

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

  • 6.
    Budh Norrbrink, Cecilia
    et al.
    Spinalis SCI unit, Karolinska Hospital and Faculty of Public Health Sciences, Karolinska Institutet, Stockholm.
    Lund, Irene
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm.
    Ertzgaard, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Neurology.
    Hulting, Claes
    Spinalis SCI unit, Karolinska Hospital and Faculty of Public Health Sciences, Karolinska Institutet, Stockholm.
    Holtz, Anders
    Department of Neurosurgery, University Hospital, Uppsala.
    Levi, Richard
    Frösunda Center, Solna and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm.
    Werhagen, Lars
    Spinalis SCI unit, Karolinska Hospital, Stockholm.
    Lundeberg, Thomas
    Spinalis SCI Unit, Karolinska Hospital, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Pain in a Swedish spinal cord injury population2003In: Clinical Rehabilitation, ISSN 0269-2155, E-ISSN 1477-0873, Vol. 17, no 6, 685-690 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To describe pain and associated variables in a prevalence group of persons with a sustained spinal cord injury (SCI) in the Swedish capital and its surroundings. Setting: Spinalis SCI Unit (outpatient clinic), Stockholm, Sweden. Design: Assessment over a 12-month period in a yearly health control. Subjects: Four hundred and fifty-six SCI patients. Results: Two hundred and ninety-one out of 456 SCI patients (63.7%) suffered from pain, and in 45.7% of these it was classified as being neurogenic. Aching pain was the most used descriptor (38.5%). The onset of pain was commonly within three months (73.5%). In 70.4% of patients pain occurred below the level of the lesion. Most patients identified pain as coming from one (55.0%) or two (28.2%) body regions. Rating of the general pain intensity on a visual analogue scale (VAS) was 46 out of 100 and rating of the worst pain intensity was 78 out of 100. Ninety-four out of 276 patients (32.3%) considered that their quality of life was significantly affected by pain. Conclusion: Pain was most common in patients with incomplete lesions (ASIA impairment grade D) and there was a correlation between pain and higher mean age at injury and between pain and female gender.

  • 7.
    Divanoglou, A
    et al.
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Levi, Richard
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Incidence of traumatic spinal cord injury in Thessaloniki, Greece and Stockholm, Sweden: a prospective population-based study2009In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 47, no 11, 796-801 p.Article in journal (Refereed)
    Abstract [en]

    Study design: Prospective population-based open-ended study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study.andlt;br /andgt;Objectives: To calculate incidence and evaluate the epidemiological profile of the incident population with traumatic spinal cord injury (TSCI). Settings: The greater Thessaloniki region in Greece and the greater Stockholm region in Sweden.andlt;br /andgt;Methods: TSCI individuals, older than 15 years of age, who had survived the first 7 days post-trauma, were identified through an active surveillance system. The forms of the Nordic Spinal Cord Injury Registry were used.andlt;br /andgt;Results: 87 individuals were injured in the greater Thessaloniki and 49 in the greater Stockholm region. Annual crude incidence was 33.6 per million for Thessaloniki and 19.5 per million for the Stockholm region. The leading causes of injury for the Thessaloniki region were transportation accidents (51%) and falls (37%), and those for the Stockholm region were falls (47%) and transportation accidents (23%). A significantly larger number of individuals of the Thessaloniki group were injured in transportation accidents. There was no significant difference between regions with regard to the type of resulting impairment.andlt;br /andgt;Conclusions: Incidence of TSCI was considerably higher in the Thessaloniki region as compared with that in the Stockholm region, probably chiefly reflecting differences in preventative measures with regard to driving. Spinal Cord (2009) 47, 796-801; doi:andlt;highlightandgt;10.1038andlt;/highlightandgt;/andlt;highlightandgt;scandlt;/highlightandgt;.andlt;highlightandgt;2009.28andlt;/highlightandgt;; published online 7 April 2009

  • 8.
    Divanoglou, A
    et al.
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Seiger, A
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Levi, Richard
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Acute management of traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study2010In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 48, no 6, 477-482 p.Article in journal (Refereed)
    Abstract [en]

    Study design: Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS).andlt;br /andgt;Objectives: To characterize patient populations and to compare acute management after traumatic spinal cord injury (TSCI).andlt;br /andgt;Settings: The Greater Thessaloniki region in Greece and the Greater Stockholm region in Sweden.andlt;br /andgt;Methods: Inception cohorts with acute TSCI that were hospitalized during the study period, that is September 2006 to October 2007, were identified. Overall, 81 out of 87 cases consented to inclusion in Thessaloniki and 47 out of 49 in Stockholm. Data from Thessaloniki were collected through physical examinations, medical record reviews and communication with TSCI cases and medical teams. Data from Stockholm were retrieved from the Nordic Spinal Cord Injury Registry.andlt;br /andgt;Results: There were no significant differences between study groups with regard to core clinical characteristics. In contrast, there were significant differences in (1) transfer logistics from the scene of trauma to a tertiary-level hospital (number of intermediate admissions, modes of transportation and duration of transfer) and (2) acute key therapeutic interventions, that is, the use of mechanical ventilation (49% in Thessaloniki versus 20% in Stockholm), and performance of tracheostomy (36% in Thessaloniki versus 15% in Stockholm); spinal surgery was performed significantly more often and earlier in Stockholm than in Thessaloniki.andlt;br /andgt;Conclusions: Despite largely similar core clinical characteristics, Stockholm and Thessaloniki cases underwent significantly different acute management, most probably to be attributed to adaptations to the differing regional approaches of care one following a systematic approach of SCI care and the other not. Spinal Cord (2010) 48, 477-482; doi: andlt;highlightandgt;10.1038andlt;/highlightandgt;/andlt;highlightandgt;scandlt;/highlightandgt;.andlt;highlightandgt;2009.160andlt;/highlightandgt;; published online 22 December 2009

  • 9.
    Divanoglou, A
    et al.
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Westgren, N
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Bjelak, S
    Rehab Station Stockholm, Stockholm, Sweden.
    Levi, Richard
    Division of Neuro-rehabilitation, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Medical conditions and outcomes at 1 year after acute traumatic spinal cord injury in a Greek and a Swedish region: a prospective, population-based study2010In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 48, no 6, 470-476 p.Article in journal (Refereed)
    Abstract [en]

    Study design: Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS).andlt;br /andgt;Objectives: To evaluate and compare outcomes, length of stay (LOS), associated conditions and medical complications at 1-year post-trauma.andlt;br /andgt;Settings: The Greater Thessaloniki region, Greece, and the Greater Stockholm region, Sweden. While Stockholm follows a SCI system of care, Thessaloniki follows a fragmented non-system approach.andlt;br /andgt;Subjects: Out of the 87 cases in Thessaloniki and the 49 cases in Stockholm who comprised the study population of STATSCIS, 75 and 42 cases respectively were successfully followed-up during the first year post-trauma.andlt;br /andgt;Results: Significantly superior outcomes (that is, survival with neurological recovery, functional ability and discharge to home) and shorter LOS for initially motor complete cases occurred in Stockholm. Management routines known to increase long-term morbidity, for example, long-term tracheostomy and indwelling urethral catheters were significantly more common in Thessaloniki. Major medical complications, that is, multiple pressure ulcers, heterotopic ossification and bacteremia/sepsis were more frequent in Thessaloniki.andlt;br /andgt;Conclusions: Our findings show how two rather similar cohorts of TSCI manifest large discrepancies in terms of 1-year outcomes and complications, depending on the type of management they receive. As the major difference between regions was the presence or absence of a SCI system of care, rather than differences in availability of modern medicine, the mere presence of the latter does not seem to be sufficient to guarantee adequate outcomes. This study provides strong evidence as to the urgent need of implementing a SCI system of care in Greece. Spinal Cord (2010) 48, 470-476; doi: andlt;highlightandgt;10.1038andlt;/highlightandgt;/andlt;highlightandgt;scandlt;/highlightandgt;.andlt;highlightandgt;2009.147andlt;/highlightandgt;; published online 22 December 2009

  • 10.
    Divanoglou, Anestis
    et al.
    Division of Neurorehabilitation, Karolinska Institutet, Stockholm, Sweden.
    Westgren, Ninni
    Division of Neurorehabilitation, Karolinska Institutet, Stockholm, Sweden.
    Seiger, Ake
    Division of Neurorehabilitation, Karolinska Institutet, Stockholm, Sweden.
    Hulting, Claes
    Division of Neurorehabilitation, Karolinska Institutet, Stockholm, Sweden.
    Levi, Richard
    Division of Neurorehabilitation, Karolinska Institutet, Stockholm, Sweden.
    Late mortality during the first year after acute traumatic spinal cord injury: a prospective, population-based study.2010In: Journal of Spinal Cord Medicine (JSCM), ISSN 1079-0268, E-ISSN 2045-7723, Vol. 33, no 2, 117-127 p.Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 11.
    Engman-Bredvik, S
    et al.
    Child and Adolescent Psychiatry, Department of Clinical Sciences , Umeå University , Umeå , Sweden..
    Carballeira, Suarez N
    Child and Adolescent Psychiatry, Department of Clinical Sciences , Umeå University , Umeå , Sweden..
    Levi, Richard
    Rehabilitation Medicine, Department of Community Medicine and Rehabilitation , Umeå University , Umeå , Sweden..
    Nilsson, K
    Child and Adolescent Psychiatry, Department of Clinical Sciences , Umeå University , Umeå , Sweden..
    Multi-family therapy in anorexia nervosa-A qualitative study of parental experiences.2016In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 24, no 2, 186-197 p.Article in journal (Refereed)
    Abstract [en]

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

  • 12.
    Ertzgaard, Per
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Levi, Richard
    Karolinska institutet Stockholm.
    Stjernberg, Leif
    Akademiska sjukhuset Uppsala.
    Gladh, Gunilla
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Mattsson, Sven
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
    Ryggmärgsskador och ryggmärgsbråck2006In: Rehabiliteringsmedicin: Teori och praktik / [ed] Borg, Jörgen, Lund: Studenlitteratur , 2006, 1, 276-287 p.Chapter in book (Other academic)
    Abstract [sv]

      Kapitel om rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården samt begrepp och metodik inleder boken. I två delar ges därefter rehabiliteringsmedicinska aspekter på de dominerande sjukdomsgrupperna - komplexa smärttillstånd respektive skador och sjukdomar i nervsystemet. Som avslutning beskrivs bland annat  stressrelaterade tillstånd. Läroboken är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under AT-tjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring. Vidareutbildningar av olika vårdyrkesgrupper kan ha nytta av boken och den kan också användas som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.

  • 13.
    Falci, S
    et al.
    Department of Neurosurgery, Craig Hospital, Denver, Colorado.
    Holtz, A
    Department of Neurosurgery, Academic Hospital, University of Uppsala, Sweden.
    Akesson, E
    department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Azizi, M
    Department of Neurosurgery, Academic Hospital, University of Uppsala, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Neuroscience and Locomotion, Rehabilitation Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Hultling, C
    The Spinalis SCI Research Unit, Karolinska Institute, Stockholm, Sweden.
    Kjaeldgaard, A
    Department of Clinical Science, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
    Levi, Richard
    department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Ringden, O
    Department of Transplantation Immunology, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
    Westgren, M
    Department of Clinical Science, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
    Lammertse, D
    department of Physical Medicine and Rehabilitation, Craig Hospital, Denver, Colorado.
    Seiger, A
    department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Obliteration of a posttraumatic spinal cord cyst with solid human embryonic spinal cord grafts: first clinical attempt.1997In: Journal of Neurotrauma, ISSN 0897-7151, E-ISSN 1557-9042, Vol. 14, no 11, 875-884 p.Article in journal (Refereed)
    Abstract [en]

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

  • 14.
    Flank, P
    et al.
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90187 Umeå, Sweden.
    Fahlström, M
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90187 Umeå, Sweden.
    Boström, C
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90187 Umeå, Sweden.
    Lewis, JE
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90187 Umeå, Sweden.
    Levi, Richard
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90187 Umeå, Sweden.
    Wahman, K
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, SE-90187 Umeå, Sweden.
    Self-reported physical activity and risk markers for cardiovascular disease after spinal cord injury.2014In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 46, no 9, 886-890 p.Article in journal (Refereed)
    Abstract [en]

    Objective: To examine whether self-reported physical activity of a moderate/vigorous intensity influences risk markers for cardiovascular disease in persons with paraplegia due to spinal cord injury.andlt;br /andgt;Design: Descriptive, cross-sectional study.andlt;br /andgt;Subjects: A total of 134 wheelchair-dependent individuals (103 men, 31 women) with chronic (≥ 1 year) post-traumatic spinal cord injury with paraplegia.andlt;br /andgt;Methods: Cardiovascular disease markers (hypertension, blood glucose and a blood lipid panel) were analysed and related to physical activity.andlt;br /andgt;Results: One out of 5 persons reported undertaking physical activity ≥  30 min/day. Persons who were physically active ≥ 30 min/day were significantly younger than inactive persons. Systolic and diastolic blood pressures were lower in the physically active group. When adjusting for age, the association between systolic blood pressure and physical activity disappeared. Physical activity ≥ 30 min/day had a tendency to positively influence body mass index and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. Men had significantly higher systolic and diastolic blood pressures than women, lower high-density lipoprotein cholesterol, higher low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and higher triglycerides. No other significant differences between men and women were found.andlt;br /andgt;Conclusion: Self-reported physical activity ≥ 30 min/day in persons with spinal cord injury positively influenced diastolic blood pressure. No other reductions in cardiovascular disease risk markers were seen after controlling for age. These results indicate a positive effect of physical activity, but it cannot be concluded that recommendations about physical activity in cardiovascular disease prevention for the general population apply to wheelchair-dependent persons with spinal cord injury.

  • 15.
    Flank, P
    et al.
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden..
    Wahman, K
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
    Levi, Richard
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
    Fahlström, M
    Department of Physical Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden.
    Prevalence of risk factors for cardiovascular disease stratified by body mass index categories in patients with wheelchair-dependent paraplegia after spinal cord injury.2012In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 44, no 5, 440-443 p.Article in journal (Refereed)
    Abstract [en]

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

  • 16.
    Forslund, E B
    et al.
    Rehab Station Stockholm R & D Unit, Neurotec Department, Karolinska Institutet, Sweden.
    Granström, A
    Rehab Station Stockholm R & D Unit, Neurotec Department, Karolinska Institutet, Sweden.
    Levi, Richard
    Rehab Station Stockholm R & D Unit, Neurotec Department, Karolinska Institutet, Sweden.
    Westgren, N
    Spinalis SCI Research Unit, Neurotec Department, Karolinska Institutet, Sweden.
    Hirschfeld, H
    Motor Control and Physical Therapy Research Laboratory, Neurotec Department, Karolinska Institutet, Sweden.
    Transfer from table to wheelchair in men and women with spinal cord injury: coordination of body movement and arm forces.2007In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 45, no 1, 41-48 p.Article in journal (Refereed)
    Abstract [en]

    Study design:A complex set-up was used to investigate kinematics and ground reaction forces.Setting:Motor Control and Physical Therapy Research Laboratory, Neurotec Department, Karolinska Institutet, Huddinge, Sweden.Objective:To investigate how men and women with spinal cord injury (SCI) perform transfers from table to wheelchair with regard to timing and magnitude of force generation beneath the hands and associated body movements.Methods:A total of 13 subjects (seven men, six women) with thoracic SCI. Kinematics of body movement were recorded (Elite 2000 system) simultaneously with the signals from three force plates (AMTI) placed beneath the buttocks and hands. Temporal and spatial parameters regarding head, trunk and trailing arm displacement, loading amplitudes and loading torque directions of both hands were analyzed for each trial and subject and compared between genders.Results:Men and women used similar amplitudes of head bending and forward displacement of the trailing shoulder, while female subjects had significantly larger trunk rotation. Both genders applied significantly more weight on the trailing hand. Differences between genders were seen in direction and timing of peak torque beneath the hands.Conclusions:The forces beneath the trailing hand were larger than those in the leading, if there is weakness or pain in one arm, this arm should be selected as the leading. To avoid excessive load on the arms, technical aids and environmental factors should be very well adapted.Sponsorship:This project was funded by the Swedish Research Council and the Health Care Science Committee of Karolinska Institutet.Spinal Cord (2007) 45, 41–48. doi:andlt;highlightandgt;10.1038andlt;/highlightandgt;/andlt;highlightandgt;sj.scandlt;/highlightandgt;.andlt;highlightandgt;3101935andlt;/highlightandgt;; published online 2 May 2006 [ABSTRACT FROM AUTHOR]

  • 17. Holtz, Anders
    et al.
    Levi, Richard
    Karolinska Institute, Sweden.
    Ryggmärgsskador: behandling och rehabilitering2006Book (Other academic)
    Abstract [sv]

    boken Ryggmärgsskador får du en samlad översikt av den kunskap som är central för vården av ryggmärgsskadade patienter.

    Boken täcker både kirurgiska och medicinska aspekter på ryggmärgsskador. Den inleds med en repetition av ryggmärgens anatomi och patofysiologi, fortsätter med det akuta omhändertagandet, klinisk och radiologisk diagnostik. viktiga medicinska följdtillstånd och de icke-traumatiska ryggmärgssjukdomarna.

    Ryggmärgsskador är användbar för en bred läsekrets med olika bakgrund såsom läkare, sjukgymnaster, sjuksköterskor m.fl. personalgrupper med arbete inom detta verksamhetsområde och utgör i sin helhet en introduktion till vården av denna svårt drabbade patientgrupp.

  • 18.
    Hultling, C
    et al.
    Karolinska institutet, Stockholm.
    Fredricsson, B
    Karolinska institutet, Stockholm.
    Garoff, L
    Karolinska institutet, Stockholm.
    Hillensjö, T
    Karolinska institutet, Stockholm.
    Levi, Richard
    Karolinska Institute, Sweden.
    Lindholm, M
    Karolinska institutet, Stockholm.
    Nylund, L
    Karolinska institutet, Stockholm.
    Rosenborg, L
    Karolinska institutet, Stockholm.
    Sjöblom, P
    Karolinska institutet, Stockholm.
    [Electroejaculation and fertilization in vitro. A method used in infertility due to spinal injury].1994In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 91, no 7, 588-590 p.Article in journal (Refereed)
  • 19.
    Hultling, C
    et al.
    Spinalis SCI Research Unit, Karolinska Hospital, Stockholm.
    Levi, Richard
    Spinalis SCI Research Unit, Karolinska Hospital, Stockholm.
    Amark, S P
    Neuropediatric Section, Astrid Lindgren Children's Hospital, Karolinska Hospital, Stockholm.
    Sjöblom, P
    Department of Obstetrics and Gynaecology, Huddinge University Hospital, Karolinska Institute, Huddinge, Sweden.
    Semen retrieval and analysis in men with myelomeningocele.2000In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 42, no 10, 681-684 p.Article in journal (Refereed)
    Abstract [en]

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

  • 20.
    Hultling, C
    et al.
    Spinal Injury Project, Karolinska Institute, Stockholm, Sweden.
    Levi, Richard
    Spinal Injury Project, Karolinska Institute,Stockholm, Sweden.
    Garoff, L
    Department of Obstetrics & Gynecology, Huddinge University Hospital, Stockholm, Sweden.
    Nylund, L
    Department of Obstetrics & Gynecology, Huddinge University Hospital, Stockholm, Sweden.
    Rosenborg, L
    Department of Obstetrics & Gynecology, Huddinge University Hospital, Stockholm, Sweden.
    Sjöblom, P
    Department of Obstetrics & Gynecology, Huddinge University Hospital, Stockholm, Sweden.
    Hillensjö, T
    Department of Obstetrics & Gynecology, Huddinge University Hospital, Stockholm, Sweden.
    Assisted ejaculation combined with in vitro fertilisation: an effective technique treating male infertility due to spinal cord injury.1994In: Paraplegia, ISSN 0031-1758, Vol. 32, no 7, 463-467 p.Article in journal (Refereed)
    Abstract [en]

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

  • 21.
    Hultling, C
    et al.
    Department of Rehabilitation Medicine, Karolinska Institute, Stockholm, Sweden.
    Rosenlund, B
    Department of Rehabilitation Medicine, Karolinska Institute, Stockholm, Sweden.
    Levi, Richard
    Department of Rehabilitation Medicine, Karolinska Institute, Stockholm, Sweden.
    Fridström, M
    Department of Rehabilitation Medicine, Karolinska Institute, Stockholm, Sweden.
    Sjöblom, P
    Department of Rehabilitation Medicine, Karolinska Institute, Stockholm, Sweden.
    Hillensjö, T
    Department of Rehabilitation Medicine, Karolinska Institute, Stockholm, Sweden.
    Assisted ejaculation and in-vitro fertilization in the treatment of infertile spinal cord-injured men: the role of intracytoplasmic sperm injection.1997In: Human Reproduction, ISSN 0268-1161, E-ISSN 1460-2350, Vol. 12, no 3, 499-502 p.Article in journal (Refereed)
    Abstract [en]

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

  • 22.
    Klefbeck, B
    et al.
    Department of Physical Therapy, Karolinska Institute, Stockholm, Sweden.
    Sternhag, M
    Department of Clinical Neuroscience, Karolinska Hospital, Stockholm, Sweden.
    Weinberg, J
    Department of Neurology, Huddinge Hospital, Huddinge, Sweden.
    Levi, Richard
    Spinalis SCI Research Unit, Karolinska Institute, Stockholm, Sweden.
    Hultling, C
    Spinalis SCI Research Unit, Karolinska Institute, Stockholm, Sweden.
    Borg, J
    Department of Clinical Neuroscience, Karolinska Hospital, Stockholm, Sweden.
    Obstructive sleep apneas in relation to severity of cervical spinal cord injury.1998In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 36, no 9, 611-628 p.Article in journal (Refereed)
    Abstract [en]

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

  • 23.
    Levi, Richard
    Umeå, Sweden.
    Philosophical Practise in Medical Rehabilitation II: Feasibility and Practical Implementation.2011In: Philosophical Practice: Journal of the American Philosophical Practitioners Association (American Philosophical Practitioners Association), ISSN 1742-8181, Vol. 6, no 3, 844-849 p.Article in journal (Refereed)
    Abstract [en]

    This paper reports a pilot implementation project of philosophical practise in a medical setting. During one year, seven medical professionals working at a neurological rehabilitation center each conducted 4

  • 24.
    Levi, Richard
    Karolinksa Institute, Sweden.
    Rullstolsburna och axelbesvär2007In: Idrottsskador: frontlinjen inom behandling och rehabilitering / [ed] Jon Karlsson, CIF , 2007, 49- p.Chapter in book (Other academic)
  • 25.
    Levi, Richard
    Karolinska Institute, Sweden.
    Ryggmärgsskador: törs vi börja hoppas?1996In: En bok om hjärnan: 32 svenska forskare om hjärnan och dess sjukdomar / [ed] Lennart Widén; Hjärnfonden, Tidén/Rabén Prisma , 1996, 323-336 p.Chapter in book (Other academic)
  • 26.
    Levi, Richard
    Karolinksa Institute, Sweden.
    Stora framsteg men ännu ingen 'BOT'2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 11, 756- p.Article in journal (Other academic)
  • 27.
    Levi, Richard
    et al.
    Karolinksa Institute, Sweden.
    Ahuja, SANJAY
    Karolinksa Institute, Sweden.
    Allmánna följdtillstånd och komplikationer2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 11, 763-767 p.Article in journal (Refereed)
    Abstract [sv]

    En ryggmärgsskada innebär en livslång benägenhet för komplikationer i samtliga organsystem. Symtombilden avviker ofta från det förväntade. Denna artikel belyser ett antal vanliga och initiala sådana tillstånd och deras handläggning.

  • 28.
    Levi, Richard
    et al.
    Karlinska Institute, Sweden.
    Ahuja, Sanjay
    Karlinska Institute, Sweden.
    [Spinal cord injuries. Neurological sequelae and complications].2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 11, 768-771 p.Article in journal (Other academic)
  • 29.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Carlberg, Lena
    Träff, Catrine
    Råsten, Malin
    West, Staffan
    115 frågor och svar om MS: Rehab Station Stockholm2007Book (Other academic)
    Abstract [en]

    n/a

  • 30.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Dahlöf, AG
    Stjernberg, L
    Ryggmärgsskador2001In: Rehabiliteringsmedicin / [ed] Olle Höök, Liber, 2001, 4, 2-14 p.Chapter in book (Other academic)
  • 31.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Divanoglou, Anestis
    Augutis, Marika
    Traumatic Spinal Cord Injury in Sweden2012In: Epidemiology of Spinal Cord Injuries / [ed] V Rahimi-Movaghar, S B Jazayeri, A R Vaccaro, Nova Science Publishers, Inc., 2012, chapter 9- p.Chapter in book (Other academic)
  • 32.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Edman, G V
    Karolinska Institute, Sweden.
    Ekbom, K
    Karolinska Institute, Sweden.
    Waldenlind, E
    Karolinska Institute, Sweden.
    Episodic cluster headache. I: Personality and some neuropsychological characteristics in male patients.1992In: Headache, ISSN 0017-8748, E-ISSN 1526-4610, Vol. 32, no 3, 119-125 p.Article in journal (Refereed)
    Abstract [en]

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

  • 33.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Edman, G V
    Karolinska Institute, Sweden.
    Ekbom, K
    Karolinska Institute, Sweden.
    Waldenlind, E
    Karolinska Institute, Sweden.
    Episodic cluster headache. II: High tobacco and alcohol consumption in males.1992In: Headache, ISSN 0017-8748, E-ISSN 1526-4610, Vol. 32, no 4, 184-187 p.Article in journal (Refereed)
    Abstract [en]

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

  • 34.
    Levi, Richard
    et al.
    Department of Neurology, Söder Hospital, Stockholm, Sweden.
    Edman, Gunnar V
    Department of Psychiatry, Karolinska Institute, Stockholm, Sweden.
    Ekbom, Karl
    Department of Neurology, Söder Hospital, Stockholm, Sweden.
    Waldenlind, Elisabet
    Department of Neurology, Söder Hospital, Stockholm, Sweden.
    Episodic cluster headache: I. Personality and some neuropsychological characteristics in male patients.1992In: Headache, ISSN 0017-8748, E-ISSN 1526-4610, Vol. 32, no 3, 119-125 p.Article in journal (Refereed)
    Abstract [en]

    The etiology and pathogenesis of cluster headache remain largely unknown. Some previous studies have focused on personality characteristics in cluster headache. However, no consistent personality profile has been found. The present study applied two personality inventories, the Karolinska Scales of Personality (KSP) and the Heart and Lifestyle Type A Measure (HALTAM), that have not previously been used in the context of cluster headache. A correlation has been suggested between left-handedness and early learning difficulties, and cluster headache.12 Thus, these variables were included and measured by inventory techniques.

    Forty-nine out of 51 consecutive male patients with episodic cluster headache participated in the present study. As compared to controls, the cluster headache patients were significantly more anxiety-prone (higher scores in the KSP Somatic anxiety and Muscular tension subscales), less successfully socialized (low scores in the KSP Socialization scale), and had a more hostile attitude towards others (higher scores in the HALTAM Hostility scale). No relationships between left-handedness or early learning difficulties, and cluster headache disease were found. The implications of the personality differences for the etiology of cluster headache disease are discussed.

  • 35.
    Levi, Richard
    et al.
    Söder Hosp, Dept of Neurology, Stockholm, Sweden.
    Edman, Gunnar V
    Department of Psychiatry and Psychology, Karolinska Institute, Stockholm, Sweden.
    Ekbom, Karl
    Söder Hosp, Dept of Neurology, Stockholm, Sweden.
    Waldenlind, Elisabet
    Söder Hosp, Dept of Neurology, Stockholm, Sweden.
    Episodic cluster headache: II. High tobacco and alcohol consumption in males.1992In: Headache, ISSN 0017-8748, E-ISSN 1526-4610, Vol. 32, no 4, 184-187 p.Article in journal (Refereed)
    Abstract [en]

    Forty-nine out of 51 consecutive male patients with episodic cluster headache were studied with regard to their smoking and drinking habits in general and in relation to cluster headache periods. Questionnaires were constructed for data regarding tobacco intake. Situation-related smoking behavior was registered according toFrith (1971). Screening for alcohol over-consumption was made using the Malmö modification of the brief Michigan Alcoholism Screening Test (Mm-MAST).

    Eighty-three percent of the patients used tobacco on a regular basis at the time of the study, with an average consumption of 20 cigarettes per day. Only 3% had never used tobacco regularly. The smoking-related desire to smoke in different situations was consistent with what is found in a general population of smokers.

    Sixty-seven percent of the patients had scores on the Mm-MAST indicative of alcohol over-consumption (i.e.heavy social drinking or alcoholism). During active headache periods 79% decreased their alcohol intake, whereas no consistent change in tobacco consumption was reported for the group as a whole. These findings were furthercorroborated by the fact that alcohol, but not tobacco intake, was reported by the majority of patients to elicit headache attacks during periods.

    Thus, our study showed high alcohol and tobacco consumption to be prominent feature in male patients with episodic cluster headache. Since neither alcohol nor tobacco appear to have properties of ameliorating headache periods or attacks, the addictive behavior in our patients more likely reflects certain personality characteristics.

  • 36.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Förvärvade ryggmärgsskador2015In: Rehabiliteringsmedicin: teori och praktik / [ed] Jörgen Borg, Kristian Borg, Björn Gerdle, Katharina Stibrant Sunnerhagen, Lund: Studentlitteratur AB, 2015, 1, 375-388 p.Chapter in book (Other academic)
    Abstract [sv]

    Rehabiliteringsmedicinsk kunskap är relevant vid alla sjukdomar och skador som medför långvariga, komplexa funktionshinder och är därför relevant inom stora delar av sjukvården. Inom den rehabiliteringsmedicinska specialiteten handläggs idag främst patienter med skador och sjukdomar i nervsystemet respektive med långvariga smärttillstånd.

    Denna reviderade upplaga inleds med en sektion som avhandlar rehabiliteringsmedicinens utveckling och nuvarande plats i sjukvården, centrala rehabiliteringsmedicinska koncept, mät- och arbetsmetoder. Följande sektioner omfattar rehabiliteringsmedicinsk funktionsdiagnostik, läkningsmekanismer och behandling vid långvariga smärttillstånd respektive vid skador och kroniska sjukdomar i nervsystemet. Bokens omfång har ökat något. Några kapitel har fått större utrymme och nya kapitel om beteendestörning och medicinska komplikationer efter svår hjärnskada liksom om anoxisk hjärnskada har tillkommit. Andra kapitel, som inte rör dagens kärnverksamhet inom praktisk rehabiliteringsmedicin, har utgått.

    Rehabiliteringsmedicin är avsedd för grundutbildning av läkare, arbetsterapeuter och sjukgymnaster, logopeder samt för läkare under ATtjänstgöring. Den är också lämplig som introduktion i specialistutbildningen i rehabiliteringsmedicin, geriatrik, neurologi och smärtlindring, i vidareutbildningar av olika vårdyrkesgrupper och som referenslitteratur av yrkesverksamma med intresse för rehabiliteringsmedicin.

  • 37.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Ertzgaard, Per
    Karolinska Institute, Sweden.
    Quality indicators in spinal cord injury care: a Swedish collaborative project. The Swedish Spinal Cord Injury Council 1998.1998In: Scandinavian journal of rehabilitation medicine. Supplement, ISSN 0346-8720, Vol. 38, 1-80 p.Article in journal (Refereed)
  • 38.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Herlofson, Jörgen
    Karolinska Institute, Sweden.
    Överlevnadsboken1997Book (Other academic)
    Abstract [en]

    n/a

  • 39.
    Levi, Richard
    et al.
    Solberga Spinal Cord Injury Research Project, Karolinska Institute Huddinge University Hospital, Stockholm, Sweden.
    Hultling, C
    Solberga Spinal Cord Injury Research Project, Karolinska Institute Huddinge University Hospital, Stockholm, Sweden.
    Nash, M S
    Solberga Spinal Cord Injury Research Project, Karolinska Institute Huddinge University Hospital, Stockholm, Sweden.
    Seiger, A
    Solberga Spinal Cord Injury Research Project, Karolinska Institute Huddinge University Hospital, Stockholm, Sweden.
    The Stockholm spinal cord injury study: 1. Medical problems in a regional SCI population.1995In: Paraplegia, ISSN 0031-1758, Vol. 33, no 6, 308-315 p.Article in journal (Refereed)
    Abstract [en]

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

  • 40.
    Levi, Richard
    et al.
    Solberga SCI Research Project, Stockholm, Sweden.
    Hultling, C
    Solberga SCI Research Project, Stockholm, Sweden.
    Seiger, A
    Solberga SCI Research Project, Stockholm, Sweden.
    The Stockholm Spinal Cord Injury Study: 2. Associations between clinical patient characteristics and post-acute medical problems.1995In: Paraplegia, ISSN 0031-1758, Vol. 33, no 10, 585-594 p.Article in journal (Refereed)
    Abstract [en]

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

  • 41.
    Levi, Richard
    et al.
    Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Hultling, C
    Solberga SCI Research Project, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Seiger, A
    Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    The Stockholm spinal cord injury study: 4. Psychosocial and financial issues of the Swedish annual level-of-living survey in SCI subjects and controls.1996In: Paraplegia, ISSN 0031-1758, Vol. 34, no 3, 152-157 p.Article in journal (Refereed)
    Abstract [en]

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

  • 42.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Hultling, C
    Karolinska Institute, Sweden.
    von Holst, H
    Karolinska Institute, Sweden.
    Ekholm, J
    Karolinska Institute, Sweden.
    [The Solberga project--a new tool for spinal cord injuries].1992In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 89, no 41, 3361-3364 p.Article in journal (Refereed)
  • 43.
    Levi, Richard
    et al.
    Solberga Project/Karolinska Institute and Centre for Neurotraumatology, Karolinska Hospital, Stockholm, Sweden.
    Hultling, C
    Solberga Project/Karolinska Institute and Centre for Neurotraumatology, Karolinska Hospital, Stockholm, Sweden.
    Westgren, N
    Solberga Project/Karolinska Institute and Centre for Neurotraumatology, Karolinska Hospital, Stockholm, Sweden.
    A computer assisted follow up system for spinal cord injury patients.1994In: Paraplegia, ISSN 0031-1758, Vol. 32, no 11, 736-742 p.Article in journal (Refereed)
    Abstract [en]

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

  • 44.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Hultling, Claes
    Ett samtal mellan Richard Levi & Claes Hultling om ryggmärgsskador2006Book (Other academic)
  • 45.
    Levi, Richard
    et al.
    Umeå University.
    Hultling, Claes
    Umeå University.
    Spinalishandboken: ny kraft för skadad ryggmärg2011 (ed. 1)Book (Other academic)
    Abstract [sv]

    En ryggmärgsskada ställer hela livet på ända. Man måste lära sig kroppens nya signaler, hur man hanterar alla tankar och känslor och hur man nu ska leva sitt liv. Spinalishandboken tar upp dels vad som händer i kroppen och hur rehabilitering går till, dels tankar om existentiella frågor, vikten av att sörja och hur man kan leva ett gott liv trots skadan.

  • 46.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Jan, Zetterström
    Karolinska Institute, Sweden.
    Olofsson, Christer
    Karolinska Institute, Sweden.
    Symtom, diagnos, terapi2014 (ed. 1)Book (Other academic)
    Abstract [sv]

    En stor del av den akuta sjukvården handläggs utanför sjukhusen. Sjukvårdsupplysningen och distriktssköterskor hänvisar flertalet oklara och misstänkt allvarligare akutfall till hälsocentralen. Andra hänvisas till egenvård eller mer eller mindre akut sjukhuskontakt. Därtill söker många patienter direkt till hälsocentral. En liten andel av dessa patienter är så uppenbart svårt sjuka, att deras akuta remittering till sjukhus är given. I de flesta fall är dock situationen betydligt svårare att handlägga. Varje dags tjänstgöring vid hälsocentral eller akutmottagning kräver hundratals bedömningar och beslut. Patienterna strömmar in utan diagnostiska etiketter och antalet möjliga orsaker är mycket stort. Processen från symtom, via diagnos, till åtgärd måste ofta genomföras vid det aktuella kontakttillfället, under stark tidspress.

    Det är precis i denna kritiska beslutssituation som denna bok vill utgöra ett användbart stöd. Den möjliggör att, på ett fåtal minuter, erinra om vad som är vanligt, vad som är viktigt och vad som är försåtligt. Den ger stöd i den primära differentialdiagnostiken i ett osorterat patientklientel, och även förslag på konkret handläggning.

    Symtom – Diagnos – Terapi är en genomgripande omarbetning av en symtombaserad handbok som författarna skrev som unga läkare 1985. Boken som helhet har granskats och kompletterats av en erfaren specialist i allmänmedicin. Den primära målgruppen är läkare verksamma inom öppen akutsjukvård. Den är av värde även för andra yrkeskategorier inom detta verksamhetsområde och för studerande på läkarutbildningen.

  • 47.
    Levi, Richard
    et al.
    Karolinksa Institute, Sweden.
    Stenfelt, Caroline
    Spinalis patient navigator: intellektuellt kapital i sjukvården1999Book (Other academic)
  • 48.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Thunberg, Krister
    Adolphson, Per B
    Boxning i rullstol2004Book (Other academic)
  • 49.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Träff, C
    Praktisk guide för kognitiv rehabilitering vid MS2010Book (Other academic)
  • 50.
    Levi, Richard
    et al.
    Karolinska Institute, Swede.
    Zetterström, Jan
    Akut diagnostik1988Book (Other academic)
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