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Biomedical subjects

Gunnar Grimby

Publications and source records attributed to Gunnar Grimby.

At least 19 recordsLinked to original sources
PubMed2006

Diaphragmatic function in advanced Duchenne muscular dystrophy.

The aim of this study was to assess diaphragm electrical activation and diaphragm strength in patients with advanced Duchenne muscular dystrophy during resting conditions. Eight patients with advanced Duchenne muscular dystrophy (age of 25 +/- 2 years) were studied during tidal breathing, maximal inspiratory capacity, maximal sniff inhalations, and magnetic stimulation of the phrenic nerves. Six patients were prescribed home mechanical ventilation (five non-invasive and one tracheotomy). Transdiaphragmatic pressure and diaphragm electrical activation were measured using an esophageal catheter. During tidal breathing (tidal volume 198 +/- 83 ml, breathing frequency 25 +/- 7), inspiratory diaphragm electrical activation was clearly detectable in seven out of eight patients and was 12 +/- 7 times above the noise level, and represented 45 +/- 19% of the maximum diaphragm electrical activation. Mean inspiratory transdiaphragmatic pressure during tidal breathing was 1.5 +/- 1.2 cmH2O, and during maximal sniff was 7.6 +/- 3.6 cmH2O. Twitch transdiaphragmatic pressure deflections could not be detected. This study shows that despite near complete loss of diaphragm strength in advanced Duchenne muscular dystrophy, diaphragm electrical activation measured with an esophageal electrode array remains clearly detectable in all but one patient.

Action Potentials↗
PubMed2006

Does a short period of rehabilitation in the home setting facilitate functioning after stroke? A randomized controlled trial.

OBJECTIVE: To assess the effect of three weeks of rehabilitation in the home setting for younger patients with stroke with the aim of improving activity level. DESIGN: A randomized controlled study with blinded evaluations at discharge, three weeks, three months and one year after discharge. SETTING: Home of the patient or the ordinary day rehabilitation clinic at the university hospital. SUBJECTS: Fifty-eight patients (median age 53 years) consecutively discharged from inpatient rehabilitation with a first occurrence of stroke participated in training directly after discharge. INTERVENTION: Rehabilitation was given for 9 hours/week over three weeks. The home group received individually tailored training, based on the patient's needs and desires, with a focus on activities in their natural context. Support and information were also given. The intervention in the day clinic group was aimed mainly at improved functions. MAIN MEASURES: The main outcome was activity, assessed with the Assessment of Motor and Process Skill (AMPS). The impairment level was also evaluated. Costs were estimated. RESULT: There were no significant differences between the groups on any of the four assessments. However, there seemed to be an earlier improvement on some measures (including AMPS) for the home group. For both groups there was a greater improvement on the activity level than on the impairment level. the costs of the home group were less than half of the costs of the day clinic group. CONCLUSION: With the present results, both rehabilitation programmes could be recommended, however, further studies are needed to define patients who may specifically benefit from the home rehabilitation programme. Costs should be taken into consideration.

Adult↗
PubMed2005

Cross-cultural validity of functional independence measure items in stroke: a study using Rasch analysis.

OBJECTIVE: To analyse cross-cultural validity of the Functional Independence Measure (FIM) in patients with stroke using the Rasch model. SETTINGS: Thirty-one rehabilitation facilities within 6 different countries in Europe. PARTICIPANTS: A total of 2546 in-patients at admission, median age 63 years. METHODS: Data from the FIM were evaluated with the Rasch model, using the Rasch analysis package RUMM2020. A detailed analysis of scoring functions of the 7 categories of the FIM items was undertaken prior to testing fit to the model. Categories were re-scored where necessary. Analysis of Differential Item Functioning was undertaken in pooled data for each of the FIM motor and social-cognitive scales, respectively. RESULTS: Disordered thresholds were found on most items when using 7 categories. Fit to the Rasch model varied between countries. Differential Item Functioning was found by country for most items. Adequate fit to the Rasch model was achieved when items were treated as unique for each country and after a few country-specific items were removed. CONCLUSION: Clinical collected data from FIM for patients with stroke cannot be pooled in its raw form, or compared across countries. Comparisons can be made after adjusting for country-specific Differential Item Functioning, though the adjustments for Differential Item Functioning and rating scales may not generalize to other samples.

Activities of Daily Living↗
PubMed2004

Dependence in daily activities and life satisfaction in adult subjects with cerebral palsy or spina bifida: a follow-up study.

PURPOSE: To study dependence in daily activities in adults with congenital disorders living in the community by interviewing them with an interval of 5 years. SUBJECTS AND METHODS: Thirty-one subjects (20 men, 11 women) aged 24-43 years at the second assessment. Twenty-two subjects had cerebral palsy, and nine had spina bifida. Interviews in the subjects' homes were conducted using Functional Independence Measure (FIM), Instrumental Activity Measure (IAM), and a questionnaire concerning life satisfaction. Rasch analysis was used for joint calibration of physical FIM- and IAM-items to obtain measure values (logits) for items and persons. RESULTS: Most subjects were independent in FIM items, but usually dependent in IAM items, except Mobility outdoors and Simple meal. The level of dependence increased significantly between the two assessments for four self-care items in FIM, Stairs and all IAM items except Mobility outdoors and Cleaning. For 13 subjects the overall level of dependence increased significantly for self-care between the two assessments. Most subjects were satisfied in life in general, but satisfaction in self-care ADL decreased between the two assessments. CONCLUSIONS: The increased dependence in daily activities demonstrated may reflect reduced capacity but also changes in preferences and interests as well as the social situation.

Activities of Daily Living↗
PubMed2004

Activity limitations in personal, domestic and vocational tasks: a study of adults with inborn and early acquired mobility disorders.

PURPOSE: To compare activity limitations at the workplace with those in the home situation. SUBJECTS AND METHODS: Sixty-nine subjects, 22-49 years of age, with inborn or early acquired mobility disorders and with experience of vocational employment were studied. They were interviewed to assess their level of dependence according to the Functional Independence Measure (FIM) and Instrumental Activity Measure (IAM) and in 22 vocation-related items. Rasch analysis was perfomed in order to assess the relative difficulty of the items. In the vocational items the subjects rated perceived difficulty on a 4-level scale. Satisfaction in one general and six domain-specific areas was rated on a 6-level scale. RESULTS: Forty-six per cent of the subjects were dependent in one or several FIM items, 90% in IAM items and 38% in the vocation-related items. In 15 of these items great difficulty was reported by few subjects. Collapsing the 7-category scale for dependence to four categories gave the best Rasch model. Most of the IAM items were the hardest to manage without assistance. FIM social-cognitive and cognitive vocation-related items were the easiest items. Most subjects were satisfied in the general and domain-specific areas. CONCLUSIONS: Activities related to household tasks and transportation demonstrated the highest level of dependence, whereas it was easier to acquire independence in most vocation-related tasks.

Activities of Daily Living↗
PubMed2004

How is walking speed related to muscle strength? A study of healthy persons and persons with late effects of polio.

OBJECTIVES: To evaluate the relationship between walking speed and muscle strength in the lower extremities in healthy persons and in persons with late effects of polio and to compare the models for these relationships. DESIGN: Retrospective analysis. SETTING: University hospital department. PARTICIPANTS: An urban sample of 144 healthy men and women (age range, 40-79 y) and 234 (146 women, 88 men) subjects with late polio. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Muscle strength in the lower extremities was measured and combined into an index. Walking speed for spontaneous and maximal walking was measured. A nonlinear regression model was developed. RESULTS: Evidence was provided for the nonlinear relationship between walking speed and strength. A specific strength threshold could not be identified. The asymptote of this curve for maximal walking was 2.57 m/s in the healthy group and 2.02 m/s in the subjects with late effects of polio. A high body mass index (>25 kg/m2) lowered the asymptote. CONCLUSIONS: It is important to prevent strength decrease that approaches the critical level where a further reduction affects walking speed more evidently. The difference in the relationship between muscle strength and walking speed for the 2 groups studied may partly depend on biomechanic imbalance between muscle groups.

Adult↗
PubMed2004

Assessing and adjusting for cross-cultural validity of impairment and activity limitation scales through differential item functioning within the framework of the Rasch model: the PRO-ESOR project.

INTRODUCTION: In Europe it is common for outcome measures to be translated for use in other languages. This adaptation may be complicated by culturally specific approaches to certain tasks; for example, bathing. In this context the issue of cross-cultural validity becomes paramount. OBJECTIVE: To facilitate the pooling of data in international studies, a project set out to evaluate the cross-cultural validity of impairment and activity limitation measures used in rehabilitation from the perspective of the Rasch measurement model. METHODS: Cross-cultural validity is assessed through an analysis of Differential Item Functioning (DIF) within the context of additive conjoint measurement expressed through the Rasch model. Data from patients undergoing rehabilitation for stroke was provided from 62 centers across Europe. Two commonly used outcome measures, the Mini-Mental State Examination (MMSE) and the Functional Independence Measure (FIM) motor scale are used to illustrate the approach. RESULTS: Pooled data from 3 countries for the MMSE were shown to fit the Rasch model with only 1 item displaying DIF by country. In contrast, many items from the FIM expressed DIF and misfit to the model. Consequently they were allowed to be unique across countries, so resolving the lack of fit to the model. CONCLUSIONS: Where data are to be pooled for international studies, analysis of DIF by culture is essential. Where DIF is observed, adjustments can be made to allow for cultural differences in outcome measurement.

Activities of Daily Living↗
PubMed2003

[Neurobiology provides a scientific foundation for rehabilitation. Report from an international symposium].

The increasing knowledge regarding central nervous function and plasticity is of great importance for modern rehabilitation. In a recent symposium, the themes covered were brain plasticity, motor control, spasticity and pain modulation. It was demonstrated that the cortex is dynamic with respect to structure as well as function, which can be observed both spontaneously and after rehabilitation interventions. An enriched environment has been proven to be of great importance for regeneration and plasticity in the central nervous system. This is also clear regarding activation and survival of the neural stem cells. "Constraint-induced therapy" has aroused considerable interest but controlled studies are needed for evaluation. The increasing knowledge regarding motor control and spasticity gives a valuable platform for clinical interventions. Knowledge about modulation of pain signals within the central nervous system will increase the therapeutic possibilities at long-standing pain, for example, concerning increased sensitivity and impaired inhibition.

Brain Diseases↗
PubMed2003

Effect of pre-exhaustion exercise on lower-extremity muscle activation during a leg press exercise.

The purpose of this study was to investigate the effect of pre-exhaustion exercise on lower-extremity muscle activation during a leg press exercise. Pre-exhaustion exercise, a technique frequently used by weight trainers, involves combining a single-joint exercise immediately followed by a related multijoint exercise (e.g., a knee extension exercise followed by a leg press exercise). Seventeen healthy male subjects performed 1 set of a leg press exercise with and without pre-exhaustion exercise, which consisted of 1 set of a knee extension exercise. Both exercises were performed at a load of 10 repetitions maximum (10 RM). Electromyography (EMG) was recorded from the rectus femoris, vastus lateralis, and gluteus maximus muscles simultaneously during the leg press exercise. The number of repetitions of the leg press exercise performed by subjects with and without pre-exhaustion exercise was also documented. The activation of the rectus femoris and the vastus lateralis muscles during the leg press exercise was significantly less when subjects were pre-exhausted (p < 0.05). No significant EMG change was observed for the gluteus maximus muscle. When in a pre-exhausted state, subjects performed significantly (p < 0.001) less repetitions of the leg press exercise. Our findings do not support the popular belief of weight trainers that performing pre-exhaustion exercise is more effective in order to enhance muscle activity compared with regular weight training. Conversely, pre-exhaustion exercise may have disadvantageous effects on performance, such as decreased muscle activity and reduction in strength, during multijoint exercise.

Adult↗
PubMed2002

[Post-polio syndrome--symptomatology and measures].

New or increased symptoms often appear decades after the onset of polio. The definition of post polio syndrome (PPS) is: a confirmed history of polio, an interval of functional stability after initial recovery, non-disuse increased muscle weakness, and other complaints such as increased general fatigue and pain. Loss of motor units is compensated by collateral re-innervation and hypertrophy of muscle fibre. An elevenfold times increase in the motor unit region can be seen, and around double the muscle fibre area, corresponding to a fivefold increase in the number of muscle fibres in the motor unit. When loss of motor neurons can no longer be compensated for, muscle strength will decrease. Respiratory problems are present in a minority, but these need special attention and intervention. Evaluation and support through a special polio clinic is of value. The trainability varies according to the type and degree of polio changes. There may be a need for technical aids, especially for mobility, but time must be allowed for patients to accept reduced physical activity and changes in life habits recommended.

Activities of Daily Living↗
PubMed2002

Exercise test in women and men aged 75-77 years.

The purpose of this study was to investigate the physiological response to an exercise test in 75- to 77-year-old women and men. Out of a systematically chosen and representative sample of 1,245 persons from a population at the age of 70, 649 individuals remained available at the age of 75-77 years. An exercise test was performed in 335 participants (52%), 174 women and 161 men. 180 (28%) were excluded because of morbidity. 131 (20%) refused to perform an exercise test. Three persons had to be excluded because of missing data. The maximal heart rate was about 140 beats/min. Heart rates at different submaximal workloads were higher in females than in males. In males there was a significant nonlinear increase in heart rate at increasing work loads while in females this was not significant. The systolic blood pressure increased more in females than in males while working on the loads 30-50 W and 50-75 W. There was a significant nonlinear increase in systolic blood pressure in men without cardiovascular drugs during exercise on 30-75 W, but the corresponding increase was not significant in women. The highest average work load for the whole group measured during at least 4 min of near-maximal exercise on a bicycle was in women 48 W and in men 66 W. Forty-four percent of the women and 22% of the men had a physical working capacity presumably interfering with their ability to perform activities of daily living.

Aged↗
PubMedDate not supplied

[Adapted exercise important after stroke. Acute and long-term effects of different training programs].

Following stroke, persons experience deficits in motor control, reduced muscle strength, disuse atrophy, reduced cardiovascular fitness and elevated energy expenditure during locomotion. Recent exercise studies with few subjects, report beneficial outcomes after strength and low intensity aerobic exercise training. Progressive strength and aerobic exercise programmes from 3 to 6 months produced gains in functional recovery and health-related functional status such as motor function, peak isokinetic torque, balance, endurance, peak aerobic capacity and overall fitness without exacerbating spasticity. Increased access to community-based physical activity programmes is recommended to prevent deconditioning and to improve health related quality of life in persons after stroke. Well-functioning rehabilitation from acute care, through special rehabilitation units to community-based physical activity programmes is important.

Continuity of Patient Care↗