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  • 51.
    Levi, Richard
    et al.
    Karolinska Institute, Sweden.
    Träff, C
    Praktisk guide för kognitiv rehabilitering vid MS2010Book (Other academic)
  • 52.
    Levi, Richard
    et al.
    Karolinska Institute, Swede.
    Zetterström, Jan
    Akut diagnostik1988Book (Other academic)
  • 53.
    Magaard, Gustaf
    et al.
    Umea Univ, Sweden.
    Wester, Per
    Umea Univ, Sweden; Karolinska Inst, Sweden.
    Levi, Richard
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Rehabilitation Medicine.
    Lindvall, Peter
    Umea Univ, Sweden.
    Gustafsson, Emma
    Umea Univ, Sweden.
    Sedeh, Arzhang Nazemroaya
    Umea Univ, Sweden.
    Lonnqvist, Malin
    Umea Univ, Sweden.
    Berggren, Stina
    Umea Univ, Sweden.
    Nyman, Kristin
    Umea Univ, Sweden.
    Hu, Xiaolei
    Umea Univ, Sweden.
    Identifying Unmet Rehabilitation Needs in Patients After Stroke With a Graphic Rehab-Compass (TM)2018In: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 27, no 11, p. 3224-3235Article in journal (Refereed)
    Abstract [en]

    Background: Unmet rehabilitation needs are common among stroke survivors. We aimed to evaluate whether a comprehensive graphic "Rehab-Compass," a novel combination of structured patient-reported outcome measures, was feasible and useful in facilitating a capture of patients rehabilitation needs in clinical practice. Methods: A new graphic overview of broad unmet rehabilitation needs covers deficits in functioning, daily activity, participation, and quality of life. It was constructed by using 5 patient-oriented, well-validated, and reliable existing instruments with converted data into a 0 (worst outcome) to 100 (best outcome) scale but unchanged in terms of variable properties. Satisfaction of the Rehab-Compass (TM) was studied by a qualitative interview of 9 patients with stroke and 3 clinicians. Practical feasibility and capacity of the instrument were evaluated in a cross sectional study with 48 patients at 5-month follow-ups after subarachnoid hemorrhage. Results: The Rehab-Compass (TM) identified and graphically visualized a panoramic view of the multidimensional needs over time which was completed before clinical consultation. The Rehab-Compass (TM) appeared to be feasible and time efficient in clinical use. The interviews of both patients and clinicians showed high satisfaction when using the Rehab-Compass (TM) graph. In the studied stroke patients, the Rehab-Compass (TM) identified memory and processing information, fatigue, mood, and pain after subarachnoid hemorrhage as the most common problems. Conclusions: The graphic Rehab-Compass (TM) seems to be a feasible, useful, and time-saving tool for identification of unmet rehabilitation needs among stroke survivors in clinical practice. Further research is needed to make the Rehab-Compass (TM) more concise and evaluate the instrument among different stroke subgroups.

  • 54.
    Nilsson, S
    et al.
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå 901 85, Sweden.
    Levi, Richard
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå 901 85, Sweden.
    Nordstrom, A
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå 901 85, Sweden.
    Treatment-resistant sensory motor symptoms in persons with SCI may be signs of restless legs syndrome2011In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 49, no 6, p. 754-756Article in journal (Refereed)
    Abstract [en]

    Study design: Case report on the successful treatment with pramipexole in four men with chronic spinal cord injury (SCI) suffering from refractory symptoms that were previously considered to be manifestations of a post-traumatic spastic syndrome or neuropathic pain.andlt;br /andgt;Objective: To raise awareness among health professionals regarding the diagnostic and therapeutic possibility of restless legs syndrome (RLS) and periodic limb movements (PLMs) in some patients with SCI responding poorly to conventional treatment for spasticity or neuropathic pain.andlt;br /andgt;Setting: Neurorehabilitation department of the Rehabilitation Medicine Center of Northern University Hospital, Umea, Sweden.andlt;br /andgt;Methods: Medical records and clinical data were retrospectively reviewed.andlt;br /andgt;Results: All cases obtained treatment with pramipexole, initially 0.09-0.72 mg day(-1). Two of the cases had RLS and PLMs, one RLS only and one PLMs only. All four reported symptoms in the lower extremities and one also in the upper extremities. Three patients with residual gait function reported RLS score with/without treatment as follows: 32/11, 37/12 and 33/12. One patient with complete paraplegia (with incomplete RLS score) reported 22/10. After a follow-up period of 16, 20, 43 and 49 months, respectively, all four still reported excellent outcomes. Two remained on initial dosage; one had increased dosage from 0.09 to 0.18 mg day(-1) and one from 0.27 to 0.80 mg day(-1) during the follow-up period.andlt;br /andgt;Conclusions: In persons with SCI suffering from infralesional involuntary movements and/or dysesthesia and with poor response to conventional antispastic or analgesic treatment, the possibility of RLS or PLMs should be considered, as these conditions seem eminently treatable. Spinal Cord (2011) 49, 754-756; doi:andlt;highlightandgt;10.1038andlt;/highlightandgt;/andlt;highlightandgt;scandlt;/highlightandgt;.andlt;highlightandgt;2010.164andlt;/highlightandgt;; published online 30 November 2010

  • 55.
    Nordgren, Camilla
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Levi, Richard
    Karolinska Institutet, Stockholm, Sweden.
    Ljunggren, Gunnar
    Karolinska Institutet, Stockholm, Sweden.
    Seiger, Ake
    Karolinska Institutet, Stockholm, Sweden.
    Societal services after traumatic spinal cord injury in Sweden.2003In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 35, no 3, p. 121-126Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Societal services after traumatic spinal cord injury in Sweden were investigated, including self-rated levels of satisfaction with the application process and resource allocation.

    DESIGN: Survey of an incidence population.

    SUBJECTS: Thirty-four persons of a total regional incidence population (n = 48) with traumatic spinal cord injury.

    METHODS: Structured interviews using a standardized questionnaire.

    RESULTS: About 25 separate services were identified being available for persons with traumatic spinal cord injury. The average number of applications per person was 5 (range 0-11). The most common service was "transportation service". Of the applications, 17% were partially or totally rejected. Most subjects received information about available services from a social worker. For 13 available services at least 1 subject claimed ignorance about its existence.

    CONCLUSIONS: In Sweden, significant resources are allocated for allowing independence and financial compensation for individuals with traumatic spinal cord injury. However, this support system sometimes also results in frustration and disappointment. Insufficient information and co-ordination are reported as weaknesses. The persons' efforts to acquire knowledge of how the system works take time which could be better used for rehabilitation and full integration into the community.

  • 56.
    Norrbrink, Budh C
    et al.
    Spinalis SCI Unit, Karolinska Hospital and Faculty of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Lund, I
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
    Hultling, C
    Spinalis SCI Unit, Karolinska Hospital and Faculty of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Levi, Richard
    Frösunda Center, Solna and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Werhagen, L
    Spinalis SCI Unit, Karolinska Hospital and Faculty of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Ertzgaard, Per
    Linköping University, Department of Clinical and Experimental Medicine, Rehabilitation Medicine. Linköping University, Faculty of Health Sciences.
    Lundeberg, T
    Spinalis SCI Unit, Karolinska Hospital and Faculty of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Gender related differences in pain in spinal cord injured individuals.2003In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 41, no 2, p. 122-128Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN:: Out of a population of 456 patients with spinal cord injuries (SCI), 130 having pain were selected after matching, based on gender, age, American Spinal Injury Association (ASIA) impairment grade and level of lesion. OBJECTIVE:: To investigate whether gender differences with regard to pain perception and prevalence exist in a population of patients following spinal cord injury. SETTING:: Spinalis SCI Unit (out-patient clinic), Stockholm, Sweden. METHOD:: 130 patients suffering from pain were assessed over a 12-month period in a yearly health control. RESULTS:: SCI women had a higher prevalence of nociceptive pain than men and their use of analgesics was greater. However, no differences between the sexes could be seen regarding pain and localization, onset, distribution, factors affecting pain, number of painful body regions, pain descriptors, ratings of pain intensities or in pain and life satisfaction. CONCLUSION:: This study showed that SCI men and women describe their pain very similarly. However, SCI women had a higher prevalence of nociceptive pain than men and their use of opiates and non-steroid anti-inflammatory drugs (NSAIDs) was greater.Spinal Cord (2003) 41, 122-128. doi:andlt;highlightandgt;10.1038andlt;/highlightandgt;/andlt;highlightandgt;sj.scandlt;/highlightandgt;.andlt;highlightandgt;3101407andlt;/highlightandgt; [ABSTRACT FROM AUTHOR]

  • 57.
    Sköld, C
    et al.
    Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Harms-Ringdahl, K
    Department of Surgical Sciences, Section of Rehabilitation Medicine, Karolinska Institute, Stockholm, Sweden.
    Hultling, C
    Spinalis SCI Research Unit, Karolinska Institute, Stockholm, Sweden.
    Levi, Richard
    Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Seiger, A
    Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Simultaneous Ashworth measurements and electromyographic recordings in tetraplegic patients.1998In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 79, no 8, p. 959-965Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: A recent prevalence study of 353 spinal cord injured (SCI) individuals in the greater Stockholm area showed problematic spasticity in 30% of this population. To treat spasticity, the evaluation becomes crucial. The modified Ashworth scale (MAS) is the clinically most-used scale to grade degree of spasticity. This study evaluated whether the MAS correlated with electromyographic (EMG) recordings of muscle activity.

    STUDY DESIGN: This cross-sectional study was performed at an outpatient clinic that has the responsibility to do a standardized, yearly follow-up of all SCI patients in the greater Stockholm area. Thirty-eight SCI individuals met the inclusion criteria; 15 of the 38 were randomly selected for the study. They were all motor-complete tetraplegic men; mean age was 33 years and mean time since injury was 9 years. Spasticity evaluation was performed by flexing and extending the knees during simultaneous EMG recordings and MAS assessment of the thigh muscle activity.

    RESULTS: Eighty percent of the individual EMG recordings correlated significantly with the corresponding Ashworth measurements. The spastic resistance, as measured both clinically and electromyographically, was stronger and lasted longer during extension than flexion movements. Spearman coefficients for correlation of quantitative spasticity measures with MAS grades were calculated. EMG and clinical measures of spasticity were more closely correlated for flexion movements. Among EMG parameters, duration of movement-associated electrical activity invariably correlated significantly with the MAS grades (p < .05). Furthermore, Ashworth measurements of movement-associated spasticity showed a positive correlation with the EMG parameters mean, peak, and start to peak of electrical activity. Each increasing grade on the MAS corresponded to increasing myoelectric activity levels for each movement.

    CONCLUSION: EMG parameters were significantly positively correlated with simultaneous MAS measurements of the spastic muscle contraction. The Ashworth scale may therefore accurately reflect the movement-provoked spasticity in motor-complete tetraplegic patients.

  • 58.
    Sköld, C
    et al.
    Department of Clinical Neuroscience and Occupational Therapy and Elderly Care Research Karolinska Institute, Stockholm, Sweden.
    Levi, Richard
    Department of Physical Therapy Karolinska Institute, Stockholm, Sweden.
    Seiger, A
    Department of Clinical Neuroscience and Occupational Therapy and Elderly Care Research Karolinska Institute, Stockholm, Sweden.
    Spasticity after traumatic spinal cord injury: nature, severity, and location.1999In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 80, no 12, p. 1548-1557Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess spasticity in a prevalence population of persons with traumatic spinal cord injury (SCI), and determine the degree of correspondence between self-reported spasticity and investigator-elicited spasticity using the modified Ashworth scale.

    DESIGN: Survey of a near total (88%) prevalence population.

    SETTING: Outpatient clinic of a university hospital.

    PATIENTS: A total of 354 individuals with SCI.

    MAIN OUTCOME MEASURES: The survey includes self-reported symptoms, neurologic examination (American Spinal Injury Association [ASIA] classification), physical therapy examination, range of motion (ROM), and complications.

    RESULTS: Presence of problematic spasticity was significantly correlated with cervical incomplete (ASIA B-D) injury. Reports of beneficial effects of spasticity were significantly less common in women. Self-reported problematic spasticity was significantly correlated with extensor spasticity. Spasticity was elicitable by movement provocation in 60% of the patients reporting spasticity. Significant correlations were found between elicitable spasticity and limited ROM.

    CONCLUSION: Flexion, extension, and abduction movements performed with the patient placed in a standardized supine test position are suitable both for test of ROM and degree of spasticity. Spasticity was not elicitable by movement provocation on physical examination in 40% of the patients who reported spasticity, thus indicating that the patient's self-report is an important complement to the clinical assessment. A significant association between spasticity and contractures (reduced ROM) was seen.

  • 59.
    Sköld, Camilla
    et al.
    Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Sweden.
    Lönn, Lars
    Department of Radiology, Body Composition and Metabolism, Sahlgrenska University Hospital, GoÈ teborg, Sweden.
    Harms-Ringdahl, Karin
    Department of Physical Therapy, Karolinska Institute and Karolinska and Huddinge University Hospitals, Sweden.
    Hultling, Claes
    Spinalis SCI Research Unit, Karolinska Institute, Stockholm, Sweden.
    Levi, Richard
    Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Sweden.
    Nash, Mark
    University of Miami School of Medicine, Miami, USA.
    Seiger, Ake
    Department of Clinical Neuroscience, Occupational Therapy and Elderly Care Research, Karolinska Institute, Sweden.
    Effects of functional electrical stimulation training for six months on body composition and spasticity in motor complete tetraplegic spinal cord-injured individuals.2002In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 34, no 1, p. 25-32Article in journal (Refereed)
    Abstract [en]

    The effect of functional electrical stimulation (FES) training on body composition, assessed by computed tomography, and the effect of spasticity, assessed by both objective and subjective measures, are evaluated. Fifteen motor-complete spinal-cord-injured men participated in the study. Eight of the 15 subjects undertook FES cycling 3 times weekly for 6 months. Whole body computed tomography scans evaluated changes in body composition. Simultaneous Modified Ashworth Scale and electromyography (EMG) measurements, resistive torque (Kin-Com) and EMG measurements, and self-ratings with Visual Analogue Scale during four consecutive days were used to evaluate changes in spasticity. Lower extremity muscle volume increased by an average of 1300 cm3 (p < 0.001) in the training group compared to the control group, who experienced no change. Otherwise no changes in body composition were seen. Significant correlations (Spearman) were found between individual EMG activity recordings and movement-provoked Modified Ashworth Scale ratings in 26% of the test situations, irrespective of group and time. The objective and subjective evaluation of movement-provoked passive (viscoelastic) and active (spasticity-related) resistance remained unchanged.

  • 60.
    Stenberg, Gunilla
    et al.
    Division of Physiotherapy, Department of Community Medicine Rehabilitation, Umeå University, Umeå, Sweden.
    Henje, Catharina
    Umeå Institute of Design, Umeå University, Umeå, Sweden.
    Levi, Richard
    Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
    Lindström, Maria
    Department of Community Medicine and Rehabilitation, Umeå University, Umeå, Sweden.
    Living with an electric wheelchair - the user perspective.2014In: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 11, no 5, p. 385-394Article in journal (Refereed)
    Abstract [en]

    Abstract Purpose: To explore the experiences of using an electric wheelchair in daily living. Methods: Fifteen participants, eight women and seven men, living in different parts of a Nordic country were interviewed. The interviews were conducted in the home or at the workplace. Open-ended questions were used. The data were collected and analyzed according to the grounded theory. Results: Analysis resulted in one core category: "Integrating the electric wheelchair - a manifold process", describing a process commencing from initial resistance against use of an electric wheelchair, to acceptance with various extent of integration. Six categories emerged that represent this core process: incorporating the electric wheelchair into the self-identity process, calculating functional consequences, encountering the reactions of others, facing duality in movability, using proactive strategies, and being at the mercy of the system. Findings indicate that the integration process is complex and manifold. Practical, personal, and social dimensions were intertwined and significantly involved. Conclusions: Integrating an electric wheelchair is a process closely connected to symbolic value, usability, community mobility and identity. These aspects should be considered in the production, prescription, and adaptation processes. Implications for Rehabilitation Integrating an electric wheelchair is a process closely connected to symbolic value, usability, community mobility, and identity. These aspects should be considered in the wheelchair production, prescription, and adaptation processes.

  • 61.
    Stenberg, M
    et al.
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, 901 85 Umeå, Sweden..
    Godbolt, AK
    Department of Clinical Sciences, Karolinska Institutet and University Department of Rehabilitation Medicine Stockholm, Danderyd Hospital, 182 88 Stockholm, Sweden..
    Nygren, De Boussard C
    Department of Clinical Sciences, Karolinska Institutet and University Department of Rehabilitation Medicine Stockholm, Danderyd Hospital, 182 88 Stockholm, Sweden..
    Levi, Richard
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, 901 85 Umeå, Sweden..
    Stålnacke, BM
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, 901 85 Umeå, Sweden..
    Cognitive Impairment after Severe Traumatic Brain Injury, Clinical Course and Impact on Outcome: A Swedish-Icelandic Study2015In: Behavioural Neurology, ISSN 0953-4180, E-ISSN 1875-8584, Vol. 2015, p. 12-, article id 680308Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the clinical course of cognitive and emotional impairments in patients with severe TBI (sTBI) from 3 weeks to 1 year after trauma and to study associations with outcomes at 1 year.andlt;br /andgt;Methods: Prospective, multicenter, observational study of sTBI in Sweden and Iceland. Patients aged 18-65 years with acute Glasgow Coma Scale 3-8 were assessed with the Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) and the Hospital Anxiety and Depression Scale (HADS). Outcome measures were Glasgow Outcome Scale Extended (GOSE) and Rancho Los Amigos Cognitive Scale-Revised (RLAS-R).andlt;br /andgt;Results: Cognition was assessed with the BNIS assessed for 42 patients out of 100 at 3 weeks, 75 patients at 3 months, and 78 patients at 1 year. Cognition improved over time, especially from 3 weeks to 3 months. The BNIS subscales "orientation" and "visuospatial and visual problem solving" were associated with the GOSE and RLAS-R at 1 year.andlt;br /andgt;Conclusion: Cognition seemed to improve over time after sTBI and appeared to be rather stable from 3 months to 1 year. Since cognitive function was associated with outcomes, these results indicate that early screening of cognitive function could be of importance for rehabilitation planning in a clinical setting.

  • 62.
    Stenberg, M
    et al.
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Bldg 9A, Umeå University Hospital, Umeå University, SE-901 85 Umeå, Sweden..
    Koskinen, LO
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Bldg 9A, Umeå University Hospital, Umeå University, SE-901 85 Umeå, Sweden.
    Levi, Richard
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Bldg 9A, Umeå University Hospital, Umeå University, SE-901 85 Umeå, Sweden.
    Stålnacke, BM
    Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Bldg 9A, Umeå University Hospital, Umeå University, SE-901 85 Umeå, Sweden.
    Severe traumatic brain injuries in Northern Sweden: a prospective 2-year study.2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 8, p. 792-800Article in journal (Refereed)
    Abstract [en]

    Objective: To assess: (i) the clinical characteristics and injury descriptors of patients with severe traumatic brain injury in Northern Sweden admitted to the single Neurotrauma Center (NC) serving this region; (ii) the care pathway of patients from injury to 3 months after discharge from the NC; and (iii) the outcomes at 3 months post-injury.andlt;br /andgt;Design: Population-based prospective 2-year cohort study.andlt;br /andgt;Patients: Patients age 17-65 years with acute severe traumatic brain injury, lowest non-sedated Glasgow Coma Scale (GCS) score of 3-8 within 24 h post-trauma.andlt;br /andgt;Methods: Patients were treated according to an intracranial pressure-oriented protocol based on the Lund concept at the NC. They were assessed at 3 weeks after injury with Rancho Los Amigos Cognitive Scale Revised (RLAS-R), Levels of Cognitive functioning, and at 3 months with RLAS-R and Glasgow Outcome Scale Extended (GOSE).andlt;br /andgt;Results: A total of 37 patients were included. Hospital deaths within 3 months post-injury occurred in 5 patients. After 3 months the RLAS-R scores were significantly improved (andlt; 0.001). Eight patients had both "superior cognitive functioning" on the RLAS-R and "favourable outcome" on the GOSE. Thirty-four patients (92%) were directly admitted to the NC. By contrast, after discharge patients were transferred back to one of several county hospitals or to one of several local hospitals, and some had multiple transfers between different hospitals and departments.andlt;br /andgt;Conclusion: Overall outcomes were surprisingly good in this group of severely injured patients. The routines for transferring patients with severe traumatic brain injury from a geographically large, sparsely populated region to a regional NC to receive well-monitored neurosurgical care seem to work very well. The post-acute clinical pathways are less clearly reflecting an optimized medical and rehabilitative strategy.

  • 63.
    Suarez, NC
    et al.
    Dept. of Clinical Sciences, Umeå University, Umeå, Sweden. Dept. of Clinical Sciences, Umeå University, Umeå, Sweden..
    Levi, Richard
    Dept. of Clinical Sciences, Umeå University, Umeå, Sweden. Dept. of Clinical Sciences, Umeå University, Umeå, Sweden..
    Bullington, J
    Dept. of Clinical Sciences, Umeå University, Umeå, Sweden. Dept. of Clinical Sciences, Umeå University, Umeå, Sweden..
    Regaining health and wellbeing after traumatic spinal cord injury.2013In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 45, no 10, p. 1023-1027Article in journal (Refereed)
    Abstract [en]

    Objective: Traumatic spinal cord injury is typically a devastating event, leading to permanent physical disability. Despite the severity of the condition, many persons with traumatic spinal cord injury manage to lead both active and independent lives. The aim of this study was to investigate the experience of health and wellbeing of persons living with a traumatic spinal cord injury for at least 20 years.andlt;br /andgt;Design and Methods: A qualitative design was used. Data was analysed using a phenomenological-hermeneutical method. Rich narratives were obtained from 14 persons with paraplegia due to traumatic spinal cord injury sustained at least 20 years ago.andlt;br /andgt;Results: The key finding was that health and wellbeing were attained when persons were able to perceive themselves as being "normal" in everyday relationships and circumstances. The normalization process involved learning to negotiate and/or prevent potentially embarrassing situations by acting in a "parallel world", covertly "behind the scenes".andlt;br /andgt;Conclusion: The subjective experience of wellbeing and health after traumatic spinal cord injury depends upon the ability to prevent or resolve potentially embarrassing situations without this being noticed by others. Performing this work "behind the scenes", enables persons with traumatic spinal cord injury to interact smoothly with others and thereby be perceived as normal, despite substantial disability.

  • 64.
    Svensson, Elin
    et al.
    Department of Child and Adolescent Psychiatry, Umea University, Umea, Sweden.
    Nilsson, Karin
    Department of Child and Adolescent Psychiatry, Umea University, Umea, Sweden, <link linkTarget="URL" linkTerm="mailto:karin.nilsson@psychiat.umu.se">karin.nilsson@psychiat.umu.se</link>.
    Levi, Richard
    Division of Rehabilitation Medicine, Department of Community Medicine and Rehabilitation, Umea University, Umea, Sweden.
    Suarez, Nivia Carballeira
    Department of Child and Adolescent Psychiatry, Umea University, Umea, Sweden.
    Parents’ experiences of having and caring for a child with an eating disorder.2013In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 21, no 5, p. 395-407Article in journal (Refereed)
    Abstract [en]

    Eating disorders (ED) are serious conditions that affect both patients and their families. Little is known about the influence of these disorders on family life in a Swedish population and the ways that affected families actually attempt to cope. The aim of this study was to specifically investigate parental experiences of having and caring for a child with ED. A qualitative approach was used and rich narratives were obtained from interviews with 10 parents. Results promote insights into lived experiences concerning social disruption, emotional impact, and coping strategies related to ED. This knowledge can be utilized to further develop programs to help affected families.

  • 65.
    Tomson, Torbjörn
    et al.
    Karolinska Inst, Stockholm, Sweden.
    Nilsson, Bengt Y
    Karolinska Inst, Stockholm, Sweden.
    Levi, Richard
    Karolinska Inst, Stockholm, Sweden.
    Impaired visual contrast sensitivity in epileptic patients treated with carbamazepine.1988In: Archives of Neurology, ISSN 0003-9942, E-ISSN 1538-3687, Vol. 45, no 8, p. 897-900Article in journal (Refereed)
    Abstract [en]

    Critical flicker fusion frequencies and visual contrast sensitivity were determined in 27 adult epileptic patients receiving carbamazepine monotherapy and in 24 healthy, drug-free control subjects. Flicker fusion thresholds were the same in patients and control subjects, whereas the contrast sensitivity was significantly reduced in the patient group at all spatial frequencies. There was a significant negative correlation between the plasma concentration of carbamazepine and the contrast sensitivity at 11.4 and 22.8 cycles per degree, indicating that the reduced contrast sensitivity was due to the drug therapy.

  • 66.
    Träff, Catrine
    et al.
    Karolinska Institute, Sweden.
    Levi, Richard
    Karolinska Institute, Sweden.
    Ett sista tabu?: en bok om MS och kognition2009Book (Other academic)
    Abstract [en]

    n/a

  • 67.
    Wahman, K
    et al.
    Department of Neurobiology, Care Sciences and Society (NVS), Division of Neurorehabilitation, Karolinska Institutet, SE-141 83 Huddinge, Sweden..
    Nash, MS
    Department of Neurobiology, Care Sciences and Society (NVS), Division of Neurorehabilitation, Karolinska Institutet, SE-141 83 Huddinge, Sweden.
    Lewis, JE
    Department of Neurobiology, Care Sciences and Society (NVS), Division of Neurorehabilitation, Karolinska Institutet, SE-141 83 Huddinge, Sweden.
    Seiger, A
    Department of Neurobiology, Care Sciences and Society (NVS), Division of Neurorehabilitation, Karolinska Institutet, SE-141 83 Huddinge, Sweden.
    Levi, Richard
    Department of Neurobiology, Care Sciences and Society (NVS), Division of Neurorehabilitation, Karolinska Institutet, SE-141 83 Huddinge, Sweden.
    Cardiovascular disease risk and the need for prevention after paraplegia determined by conventional multifactorial risk models: the Stockholm spinal cord injury study.2011In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 43, no 3, p. 237-242Article in journal (Refereed)
    Abstract [en]

    Objective: To assess the need for intervention on cardio-vascular disease risks in persons with paraplegia according to: (i) two multifactorial risk models; and (ii) these models in combination with the additional risk of overweight/obesity.andlt;br /andgt;Design: Cross-sectional.andlt;br /andgt;Subjects: A total of 134 out of 153 persons, comprising more than 80% of a regional prevalence population with traumatic paraplegia (American Spinal Injury Association Impairment Scale A-C) of minimum one year duration.andlt;br /andgt;Methods: Participants were screened for cardiovascular disease risk using two multifactorial risk models: the Systematic Coronary Risk Evaluation and the Framingham Risk Equation. Risk factors included were: age, gender, systolic blood pressure, antihypertensive medication, smoking, total cholesterol, high-density lipoprotein cholesterol, and total cholesterol/total cholesterol ratio. In addition, overweight/obesity was assessed by body mass index.andlt;br /andgt;Results: Twenty-seven percent to 36% of the cohort was eligible for cardiovascular disease risk intervention, depending on the risk model used. When overweight/obesity (spinal cord injury adjusted cut-score body mass index ≥ 22) was also considered, over 80% of the participants qualified for intervention.andlt;br /andgt;Conclusion: Almost one-third of persons with paraplegia were eligible for cardiovascular disease risk intervention according to authoritative assessment tools. The number in need of intervention was dramatically increased when overweight/obesity as a cardiovascular disease risk was considered.

  • 68.
    Wahman, K
    et al.
    Department of Neurobiology, Care Sciences and Society (NVS), Division of neurorehabilitation, Karolinska Institutet, 139 89 Stockholm, Sweden..
    Nash, MS
    Department of Neurobiology, Care Sciences and Society (NVS), Division of neurorehabilitation, Karolinska Institutet, 139 89 Stockholm, Sweden.
    Lewis, JE
    Department of Neurobiology, Care Sciences and Society (NVS), Division of neurorehabilitation, Karolinska Institutet, 139 89 Stockholm, Sweden.
    Seiger, A
    Department of Neurobiology, Care Sciences and Society (NVS), Division of neurorehabilitation, Karolinska Institutet, 139 89 Stockholm, Sweden.
    Levi, Richard
    Department of Neurobiology, Care Sciences and Society (NVS), Division of neurorehabilitation, Karolinska Institutet, 139 89 Stockholm, Sweden.
    Increased cardiovascular disease risk in Swedish persons with paraplegia: The Stockholm spinal cord injury study.2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 5, p. 489-492Article in journal (Refereed)
    Abstract [en]

    Objective: Comparison of prevalence of cardiovascular disease risks in persons with chronic traumatic paraplegia with those in the general population.andlt;br /andgt;Design: Cross-sectional comparative study.andlt;br /andgt;Subjects: A total of 135 individuals, age range 18-79 years, with chronic (andgt; or = 1 year) traumatic paraplegia.andlt;br /andgt;Methods: The prevalences of diabetes mellitus, dyslipidaemia, hypertension, overweight, and smoking, were assessed in the study population and were compared with an age- and gender-matched sample of the general population in the region under study. History of myocardial infarction and medication for dyslipidaemia, hypertension, and diabetes mellitus were also recorded. chi2 tests were used to compare the paraplegic cohort with the general population sample.andlt;br /andgt;Results: Significantly more persons with paraplegia reported a history of myocardial infarction (5.9%) than those in the comparison group (0.7%). The prevalences of diabetes mellitus (5.9%), dyslipidaemia (11.1%), and hypertension (14.1%) were also significantly higher in the paraplegic group, as were drug treatment for these disorders.andlt;br /andgt;Conclusion: Persons with paraplegia report increased prevalences of diabetes mellitus, hypertension, and dyslipidaemia, in particular, compared with the general population. Population-based screening and therapeutic counter-measures for these conditions may therefore be particularly indicated for this patient group.

  • 69.
    Wahman, Kerstin
    et al.
    Rehab Station Stockholm, Stockholm, Sweden.
    Biguet, Gabriele
    Neurotec Department, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden.
    Levi, Richard
    Rehab Station Stockholm, Stockholm, Sweden.
    What promotes physical activity after spinal cord injury? An interview study from a patient perspective.2006In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 28, no 8, p. 481-488Article in journal (Refereed)
    Abstract [en]

    Purpose. Physical activity in people with traumatic spinal cord injury (SCI) is of importance not only for maintaining health but also for increasing the possibilities of living an independent life. Physical inactivity leads to poorer muscular and cardiovascular conditioning and sub-optimal levels of functioning. To help people with SCI to achieve optimum physical activity, it is important to understand what promotes the incorporation of regular physical activity into daily life. The aim of this study was thus to identify factors that may promote participation in physical activity among people with spinal cord injuries.Method. Qualitative multiple case studies. Sixteen participants with SCI were interviewed.Result. Four main themes of promoting factors could be identified. They were: using cognitive and behavioural strategies; finding supporting environmental solutions; exploring motivation post injury; and capturing new frames of reference.Conclusion. By utilising the motivational power of role models, together with the other motivational factors identified in this study, such as identifying relevant individual motives post injury and capturing new frames of reference, the process towards physical active life may be facilitated.

  • 70. Wahman, Kerstin
    et al.
    Levi, Richard
    Karolinksa Institute, Sweden.
    Hälsoboken: en guide för dig som lever länge med ryggmärgsskada2006Book (Other academic)
    Abstract [en]

    This book, written in Swedish, is specifically directed at the person with a spinal cord injury (SCI), wishing to know how to promote a healthy lifestyle in the face of living with a life-long disability. A more recent book by Kerstin Wahman and Annacarin Lagerström - available in Swedish and in English - incorporates most if not all of the messages in this book, and is thus to be recommended. Still, I feel proud to having had the opportunity to help putting lifestyle issues "on the map" for SCI, as this without a doubt is a high risk group for lifestyle-related morbidity (and mortality) due to an increased vulnerability. This important fact has been all-too-long neglected, at the peril of the patients.

  • 71.
    Wahman, Kerstin
    et al.
    Department of Neurobiology, Care Sciences and Society, Division of Neurorehabilitation, Karolinska Institutet.
    Nash, Mark S
    University of Miami Miller School of Medicine, Miami, Florida, USA.
    Westgren, Ninni
    Spinalis Spinal Cord Injury Rehabilitation Unit, Karolinska University Hospital, Stockholm, Sweden.
    Lewis, John E
    University of Miami Miller School of Medicine, Miami, Florida, USA.
    Seiger, Ake
    Department of Neurobiology, Care Sciences and Society, Division of Neurorehabilitation, Karolinska Institutet.
    Levi, Richard
    Department of Neurobiology, Care Sciences and Society, Division of Neurorehabilitation, Karolinska Institutet.
    Cardiovascular disease risk factors in persons with paraplegia: the Stockholm spinal cord injury study.2010In: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, no 3, p. 272-278Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine cardiovascular disease risk factors and risk clusters in Swedish persons with traumatic wheelchair-dependent paraplegia.

    DESIGN: Prospective examination.

    SUBJECTS: A total of 135 individuals aged 18-79 years with chronic (>or= 1 year) post-traumatic paraplegia.

    METHODS: Cardiovascular disease risk factors; dyslipidemia, impaired fasting glucose, hypertension, overweight, smoking, and medication usage for dyslipidemia, hypertension, and diabetes mellitus, were analyzed according to authoritative guidelines. Stepwise regression tested the effects of age, gender, and injury characteristics on cardiovascular disease risks.

    RESULTS: High-prevalence risk factors were dyslipidemia (83.1%), hypertension (39.3%), and overweight (42.2%) with pervasive clustering of these risks. Being older was related to increased cardiovascular disease risk, except for dyslipidemia. Hypertension was more common in low-level paraplegia. Prevalence of impaired fasting glucose was lower than previously reported after paraplegia. A high percentage of persons being prescribed drug treatment for dyslipidemia and hypertension failed to reach authoritative targets for cardiovascular disease risk reduction.

    CONCLUSION: Swedish persons with paraplegia are at high risk for dyslipidemia, hypertension, and overweight. Impaired fasting glucose was not as common as reported in some previous studies. Pharmacotherapy for dyslipidemia and hypertension often failed to achieve recommended targets. Population-based screening and therapeutic countermeasures to these cardiovascular disease risks are indicated.

  • 72.
    Westgren, N
    et al.
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Hultling, C
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Levi, Richard
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Seiger, A
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Westgren, M
    Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden.
    Sexuality in women with traumatic spinal cord injury.1997In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 76, no 10, p. 977-983Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Sexuality in spinal cord injured women has largely been neglected. One reason may be the male dominance amongst traumatically spinal cord injured individuals. The purpose of this study is to elucidate sexual issues in women with spinal cord injuries.

    METHODS: Survey of near-total prevalence population in the greater Stockholm area. Structured interview, based on a standardized questionnaire. Self-rating scales for evaluation of the importance of sexual activity before and after injury and for defining and rating the medical problem most significantly interfering with sexual activity. Marital status and/or partnership pre- and post-injury and information on sexual matters provided after injury were evaluated in detail. Out of a total 65 women, 62 participated in the study.

    RESULT: Women with complete and incomplete cervical lesions rated the importance of sexual activity significantly lower after, as compared to before, spinal cord injury. No significant differences were found in women with lower-level lesions. Urinary leakage, spasticity and positioning problems were the medical problems most significantly interfering with partner-related sexual activity. Only six women had received information on sexual matters before discharge from hospital. None of the partners had received such information.

    CONCLUSION: The women's neurological status affect their ability to adapt sexually after injury. Medical problems commonly interfere with sexuality and should be identified and treated. No adverse impact of spinal cord injury on marital status could be confirmed. Sexual counseling has yet to become an integral part of rehabilitation.

  • 73.
    Westgren, N
    et al.
    Karolinska Hospital, Stockholm, Sweden.
    Hultling, C
    Karolinska Hospital, Stockholm, Sweden.
    Levi, Richard
    Karolinska Hospital, Stockholm, Sweden.
    Westgren, M
    Karolinska Hospital, Stockholm, Sweden.
    Pregnancy and delivery in women with a traumatic spinal cord injury in Sweden, 1980-1991.1993In: Obstetrics and Gynecology, ISSN 0029-7844, Vol. 81, no 6, p. 926-930Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate the incidence of delivery in women after a traumatic spinal cord injury and to describe pregnancy outcome in this group of patients.

    METHODS: Between 1980

  • 74.
    Westgren, N
    et al.
    Solberga Project, Karolinska Institute and Centre for Neurotraumatology, Karolinska Hospital,, Stockholm, Sweden.
    Levi, Richard
    Solberga Project, Karolinska Institute and Centre for Neurotraumatology, Karolinska Hospital, Stockholm, Sweden.
    Motherhood after traumatic spinal cord injury.1994In: Paraplegia, ISSN 0031-1758, Vol. 32, no 8, p. 517-523Article in journal (Refereed)
    Abstract [en]

    The present study includes all women with a traumatic spinal cord injury in Sweden who became pregnant and delivered live infants during 1980-1991. This group comprises six tetraplegic and 20 paraplegic patients, all confined to a wheelchair. During the above mentioned period the patients had delivered a total of 47 children. The study evaluated parental ability and quality of family life as regards interpersonal relationships, family relationships, social integration, recreational interests and demand for external assistance. An individual standardised interview was performed with all patients. In addition a standardised questionnaire was sent to all spouses (n = 20) and to all children above 10 years of age (n = 10). All 26 patients participated, 18 spouses completed and returned the questionnaires and all children took part in the study. We found an overall favourable outcome as regards the parameters evaluated. The families seem to live a rich and complete family life with very little demand for external help. They report a well functioning social network and seem socially integrated both as individuals and as families. To conclude, the study indicates that there is no reason to question females with an SCI in their roles as parents. The spinal cord injury per se, in females, thus does not preclude the possibility of having a family and caring for children adequately.

  • 75.
    Westgren, N
    et al.
    Spinalis SCI Research Unit and Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Levi, Richard
    Spinalis SCI Research Unit and Department of Clinical Neuroscience and Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Quality of life and traumatic spinal cord injury.1998In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 79, no 11, p. 1433-1439Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To determine associations between major outcome variables after traumatic spinal cord injury (SCI) and quality of life (QL).

    SUBJECTS: Of a total population of 353 SCI patients, 320 participated, 261 men and 59 women living in the greater Stockholm area: 124 were tetraplegic, 176 were paraplegic, and 20 had no classified level. Mean age was 42 years (range, 17 to 78).

    METHOD: The Swedish SF-36 Health Survey was used to assess QL. The SF-36 is a self-administered questionnaire containing 36 items, divided into 8 multi-item dimensions, covering physical function, physical and emotional role function, social function, bodily pain, mental health, vitality and overall evaluation of health. Neurologic, general medical, and psychosocial variables were obtained from the Stockholm Spinal Cord Injury Study (SSCIS) data base. QL indices were analyzed for the SCI group as a whole, as well as for subgroups. Descriptors for subgroups were demographic variables, presence or absence of common medical problems, and subjective evaluation of the degree of impact of the medical problem on well-being/daily activities.

    RESULTS: QL in individuals with SCI was significantly lower in all subscales as compared with a normative population. No difference in QL was seen in subgroups according to extent of lesion, with the exception of physical functioning. Several medical complications such as neurogenic pain, spasticity, and neurogenic bladder and bowel problems were associated with lower QL scores.

    SUMMARY: QL, as defined by SF-36, is better in persons injured many years ago, as compared with those recently injured, suggesting an adaptive process operating over a long period. The presence of complicating medical problems, such as severe pain, problematic spasticity, and incontinence, seem to have more negative effects on QL than the extent of SCI as such.

  • 76.
    Westgren, Ninni
    et al.
    Spinalis SCI Research Unit, Karolinska Hospital and Department of Clinical Neuroscience and Family Medicine,Karolinska Institute, Stockholm, Sweden .
    Levi, Richard
    Spinalis SCI Research Unit, Karolinska Hospital and Department of Clinical Neuroscience and Family Medicine,Karolinska Institute, Stockholm, Sweden .
    Sexuality After Injury: Interviews with Women After Traumatic Spinal Cord Injury1999In: Sexuality and disability, ISSN 0146-1044, E-ISSN 1573-6717, Vol. 7, no 4, p. 309-319Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to illuminate sexual experiences in women after traumatic spinal cord injury (SCI), including psychological, physical and social barriers that will have to be overcome to resume a sexually active life with a partner. Interviews with eight women were performed. The women were 20–43 years old, previously healthy, with experience of stable heterosexual relationships both before and after SCI. The interviews covered three main areas: 1. The first sexual contact after injury: expectations, concerns, outcome; 2. Communication with partner on sexual matters, before and after injury; and 3. Sexual activity after injury: limitations, compensatory strategies. In addition, advice from the women to newly injured and rehabilitation staff/counselors was requested. Results suggest a strong influence of pre-injury sexual behaviour on post-injury sexual adaptation. A positive attitude towards sexuality and good communicative skills seem to be of particular importance for a favourable outcome of sexual rehabilitation. Even under such circumstances, however, SCI as a rule leads to significant loss of sexual ability. A realistic approach is therefore recommended in counseling, taking the mourning of loss of function into consideration, and allowing the patients to express their grief. Thus, sexual rehabilitation programs need to address a dynamic process of mourning and coping, rather than merely teaching skills for having sexual intercourse after SCI.

  • 77.
    Österåkeri, A-L
    et al.
    Karolinska Institute, NEUROTEC, Stockholm, Sweden.
    Levi, Richard
    Karolinska Institute, NEUROTEC, Stockholm, Sweden.
    Indicators of psychological distress in postacute spinal cord injured individuals.2005In: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 43, no 4, p. 223-229Article in journal (Refereed)
    Abstract [en]

    STUDY DESIGN::Consecutive inclusion of spinal cord injured patients admitted for postacute rehabilitation from June 2000 to January 2002. OBJECTIVE::Assessment of prevalence of indicators of psychological distress in the subacute and early chronic stages after acute-onset spinal cord injury (SCI). SETTING::A Swedish rehabilitation center. METHODS::In all, 36 patients participated. Psychological assessment was obtained at admission, discharge and 6 months follow-up by psychological measures based on the DSM-IV (ie Becks Depression Inventory, SPIFA, SCID-screen, AUDIT) and clinical interview. Ongoing psychotropic medication was noted. RESULTS::Clinical depression was infrequent. However, ongoing psychotropic medication was common, possibly indicating a relatively high incidence of underlying depressive and anxiety disorders. In all, 25%of the sample showed indicators of high alcohol consumption. Few patients had a previously diagnosed personality disorder. By contrast, there was frequent occurrence of personality traits outside normal ranges. CONCLUSION::Medication of psychological problems commonly occurs after SCI, especially for depression and anxiety. There are indications of alcohol overconsumption in a substantial minority of SCI patients. The study raises the question of whether suppression of psychological symptoms by drug therapy is the optimal treatment of such problems in a rehabilitation process. SPONSORSHIP::This study was funded by grants from‘Stiftelsen Tekniska Hjälpmedelåt Handikappade’.Spinal Cord (2005) 43, 223-229. doi:andlt;highlightandgt;10.1038andlt;/highlightandgt;/andlt;highlightandgt;sj.scandlt;/highlightandgt;.andlt;highlightandgt;3101703andlt;/highlightandgt;; Published online 7 December 2004 [ABSTRACT FROM AUTHOR]

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