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  • 51.
    Jörgensen, Sophie
    et al.
    Department of Health Sciences, PO Box 157, Lund University.
    Iwarsson, Susanne
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering. Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University.
    Secondary health conditions, activity limitations, and life satisfaction in older adults with long-term spinal cord injury2017Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 9, nr 4, s. 356-366Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    Many individuals with a spinal cord injury (SCI) have lived several decades with their injury, leading to a need for a deeper understanding of factors associated with healthy aging in people with long-term SCI.

    Objectives

    To (1) describe secondary health conditions, activity limitations, and life satisfaction in older adults with long-term SCI, and to (2) investigate how sociodemographics, injury characteristics, and secondary health conditions are associated with their activity limitations and life satisfaction.

    Design

    Cross-sectional descriptive cohort study.

    Setting

    Home and community settings.

    Participants

    A total of 123 individuals (71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years.

    Methods

    Baseline data as part of the Swedish Aging with Spinal Cord Injury Study. Associations between variables were investigated with multivariable linear regression analyses.

    Main Outcome Measurements

    Bowel and bladder function, nociceptive and neuropathic pain, spasticity, the Spinal Cord Independence Measure, third version, and the Satisfaction With Life Scale.

    Results

    Bowel-related and bladder-related problems were reported by 32% and 44%, respectively, 66% reported moderate or severe nociceptive and/or neuropathic pain, and 44% reported spasticity. Activity limitations were moderate (mean Spinal Cord Independence Measure, third version, total score 65.2, range 8-100) where injury characteristics and spasticity explained 68% of the variance. Higher level and more severe SCI (based on the American Spinal Injury Association Impairment Scale) exhibited the strongest association with more activity limitations. Life satisfaction was rated just above the midpoint between satisfied and dissatisfied with life (mean Satisfaction With Life Scale total score 20.7, range 6-34). Marital status, vocational situation, bladder function and injury characteristics explained 38% of the variance, where having a partner showed the strongest association with greater life satisfaction. Activity limitations and life satisfaction were not associated with gender, age and time since injury.

    Conclusion

    Older adults with long-term SCI can maintain a relatively high level of physical independence and generally are satisfied with their lives, regardless of gender, age or time since injury. The associations demonstrate the importance of injury characteristics for the performance of daily activities and the social context for life satisfaction in older adults with long-term SCI.

    Level of Evidence

    III

  • 52.
    Jörgensen, Sophie
    et al.
    Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University.
    Martin Ginis, K.A.
    School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, BC.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Leisure time physical activity among older adults with long-term spinal cord injury2017Inngår i: Spinal Cord, ISSN 1362-4393, E-ISSN 1476-5624, Vol. 55, nr 9, s. 848-856Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    STUDY DESIGN:

    Cross-sectional.

    OBJECTIVES:

    To describe participation in leisure time physical activity (LTPA) (amount, intensity and type) among older adults with long-term spinal cord injury (SCI), and to investigate the associations with sociodemographics, injury characteristics and secondary health conditions (SHCs).

    SETTING:

    Home settings in southern Sweden.

    METHODS:

    Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). The physical activity recall assessment for people with SCI was used to assess LTPA among 84 men and 35 women (mean age 63.5 years, mean time since injury 24 years, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D). Associations were analyzed statistically using hierarchical multivariable regression.

    RESULTS:

    Twenty-nine percent reported no LTPA, whereas 53% performed moderate-to-heavy intensity LTPA. The mean minutes per day of total LTPA was 34.7 (±41.5, median 15, range 0-171.7) and of moderate-to-heavy LTPA 22.5 (±35.1, median 5.0, range 0-140.0). The most frequently performed activities were walking and wheeling. Sociodemographics, injury characteristics and SHCs (bowel-related and bladder-related problems, spasticity and pain) explained 10.6% and 13.4%, respectively, of the variance in total and moderate-to-heavy LTPA. Age and wheelchair use were significantly, negatively associated with total LTPA. Women, wheelchair users and employed participants performed significantly less moderate-to-heavy LTPA than men, those using walking devices/no mobility device and unemployed participants.

    CONCLUSION:

    Many older adults with long-term SCI do not reach the amount or intensity of LTPA needed to achieve fitness benefits. Research is needed on how to increase LTPA and to identify modifiable factors that could enhance their participation.Spinal Cord advance

  • 53.
    Jörgensen, Sophie
    et al.
    Department of Health Sciences, PO Box 157, Lund University.
    Martin Ginis, Kathleen A.
    School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, BC.
    Iwarsson, Susanne
    Department of Health Sciences, Lund University.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Depressive symptoms among older adults with long-term spinal cord injury: Associations with secondary health conditions, sense of coherence, coping strategies and physical activity2017Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 8, s. 644-651Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVES:

    To assess the presence of depressive symptoms among older adults with long-term spinal cord injury and investigate the association with sociodemographic and injury characteristics; and to determine how potentially modifiable factors, i.e. secondary health conditions, sense of coherence, coping strategies and leisure-time physical activity, are associated with depressive symptoms.

    DESIGN:

    Cross-sectional study.

    SUBJECTS:

    A total of 122 individuals (70% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years.

    METHODS:

    Data from the Swedish Aging with Spinal Cord Injury Study, collected using the Geriatric Depression Scale-15, the 13-item Sense of Coherence Scale, the Spinal Cord Lesion-related Coping Strategies Questionnaire and the Physical Activity Recall Assessment for people with Spinal Cord Injury. Associations were analysed using multivariable linear regression.

    RESULTS:

    A total of 29% reported clinically relevant depressive symptoms and 5% reported probable depression. Sense of coherence, the coping strategy Acceptance, neuropathic pain and leisure-time physical activity explained 53% of the variance in depressive symptoms.

    CONCLUSION:

    Older adults with long-term spinal cord injury report a low presence of probable depression. Mental health may be supported through rehabilitation that strengthens the ability to understand and confront life stressors, promotes acceptance of the injury, provides pain management and encourages participation in leisure-time physical activity.

  • 54.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Fisher, Anne G.
    Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University.
    Lexell, Jan
    Benspång, Birgitta
    Department of Community Medicine and Rehabilitation, Occupational Therapy, Umeå University.
    Impact on participation and autonomy questionnaire: internal scale validity of the Swedish version for use in people with spinal cord injury2007Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 39, nr 2, s. 156-162Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To evaluate aspects of internal scale validity and reliability of the Swedish version of the Impact on Participation and Autonomy questionnaire (IPA-S) for use in people with spinal cord injury. Subjects: A total of 161 persons with spinal cord injury. Method: IPA-S psychometric properties were evaluated using Rasch rating scale analysis. Results: The results show that the IPA-S has 27 items for perceived participation and 6 items for perceived problems with participation, indicating 2 underlying unidimensional constructs for use in people with spinal cord injury, after removal of misfitting items. The established hierarchical order of the item calibration values in both scales appeared logical and the distances between the items, with a few exceptions in the problem scale, were appropriate. Both scales demonstrated good separation reliability. The range of item calibration values in both scales did not fully cover the range of measures of persons' perceived participation and problems thereof. Conclusion: The psychometric properties of IPA-S are promising and indicate that IPA-S has potential to be developed further.

  • 55.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    A positive turning point in life: how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme2010Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 42, nr 6, s. 559-565Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To describe and enhance our understanding of how persons with late effects of polio experience the influence of an interdisciplinary rehabilitation programme. Participants: Twelve persons with clinically verified late effects of polio who had participated in an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme. Methods: Qualitative research interviews analysed using the constant comparative method of grounded theory. Results: The rehabilitation programme was experienced as a turning point in the participants' lives. Before rehabilitation they felt they were on a downward slope without control. Rehabilitation was the start of a process of change whereby they acquired new skills, which, over time, contributed to a different but good life. After approximately a year, they had a sense of control and had accepted life with late effects of polio. They had also established new habits, taken on a changed valued self and could look to the future with confidence. Conclusion: This qualitative study has shown that persons with late effects of polio can benefit from an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme and experience positive changes in their manage­ment of daily activities and in their view of their late effects of polio, their future and their self.

  • 56.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Associations between perceptions of environmental barriers and participation in persons with late effects of polio2009Inngår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 16, nr 4, s. 194-204Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this pilot study was to assess the association between perceived environmental barriers and perceived participation in everyday life situations encountered by people with late effects of polio. A sample of 45 persons with clinically verified late effects of polio answered the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA-S) and the Craig Hospital Inventory of Environmental Factors (CHIEF-S). The relationships between the perceived occurrence of a broad range of environmental barriers and perception of participation in life situations and problems with participation were explored. The majority of the respondents perceived that they encountered environmental barriers, but their occurrence was generally infrequent and their magnitude tended to be low. The barriers identified in the physical/structural subscale were generally most strongly related to problems with participation, compared with the four other environmental subscales. A high frequency of never encountering environmental barriers in the three subscales physical/structural, work and education, and policies in CHIEF-S were significantly related to more reports of good participation in IPA-S. These associations indicate that the participation of those with late effects of polio is influenced by their perception of the barriers they encounter. Further studies of these concepts can provide a greater understanding of disabilities and help us to promote participation in life situations for people with late effects of polio.

  • 57.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Delaktighet och omgivningsfaktorer i ICF: möjligheter och utmaningar vid användning inom rehabilitering2009Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, nr 13, s. 932-935Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Med ICF (International classification of functioning, disability and health) och fokus på innebörden av delaktighetsbegreppet och omgivningsfaktorer ökar möjligheterna att utveckla rehabiliteringen för personer med funktionshinder. Forskning visar att olika grupper av personer med funktionshinder kan känna god delaktighet och att detta relaterar till hög livstillfredsställelse, medan hinder i omgivningen påverkar delaktigheten negativt. Inom rehabiliteringen är det därför viktigt att identifiera underlättande faktorer i omgivningen och förändra omgivningsfaktorer i positiv riktning för att stärka delaktigheten. Fortsatt forskning behövs för att öka kunskapen om delaktighet och betydelsen av olika omgivningsfaktorer hos personer med funktionshinder. Ett fortsatt utvecklingsarbete behövs också för att på ett optimalt sätt använda delaktighetsbegreppet och omgivningsfaktorerna i det kliniska rehabiliteringsarbetet.

  • 58.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Life satisfaction in persons with late effects of polio2011Inngår i: Applied Research in Quality of Life, ISSN 1871-2584, E-ISSN 1871-2576, Vol. 6, nr 1, s. 71-80Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To assess satisfaction with life as a whole and with ten domains of life satisfaction in Swedish persons with late effects of polio, to describe the relationship with sex, age, marital status, use of mobility aids and self-perceived needs of instrumental support, and to compare the level of life satisfaction with a Swedish reference sample. A cross-sectional study of 160 persons with verified late effects of polio answered a postal questionnaire including the Life Satisfaction Questionnaire (LiSat-11). A majority were to some degree satisfied with life as a whole and with all the ten domains of life satisfaction. Satisfaction with life as whole was not related to any of the sociodemographic or disability related factors and these factors had few relations to the ten domains of life satisfaction. The respondents were significantly less satisfied with life as a whole and with vocation, leisure, sexual life, activities of daily living, and somatic and psychological health compared to the Swedish reference sample, but were significantly more satisfied with economy and contacts with friends. Men and women with late effects of polio, regardless of age, marital status or disability, can experience a reduced life satisfaction. This emphasises the need to identify potential gaps between these persons' aspirations and achievements in life and carry out appropriate rehabilitation interventions to enhance their life satisfaction

  • 59.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Perceived participation in life situations in persons with late effects of polio2008Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 40, nr 8, s. 659-664Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To investigate how persons with late effects of polio perceive their participation and problems with participation in life situations and to determine the association between perceived problems with participation and sex, age, marital status, use of mobility aids and access to instrumental support.Design: Cross-sectional.Subjects: A total of 160 persons with prior polio 6-30 months after an individualized, goal-oriented, comprehensive interdisciplinary rehabilitation programme.Methods: All subjects answered the Swedish version of the Impact on Participation and Autonomy Questionnaire.Results: A majority of the respondents perceived their participation as sufficient in most activities and 65% of the respondents perceived no severe problems with participation. The remaining 35% perceived 1-6 severe problems with participation. All 5 domains of participation were positively correlated with the 9 items for problem experience. Most restrictions in participation were reported in the domains of Family role, Autonomy outdoors, and Work and education. Insufficient instrumental support was most strongly associated with the perception of severe problems with participation.Conclusion: Rehabilitation programmes for persons with late effects of polio need to focus on areas of participation that are perceived as a problem by these persons and to promote access to a supportive environment to enhance their participation.

  • 60.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Medicinsk vetenskap.
    Relationship between participation in life situations and life satisfaction in persons with late effects of polio2009Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 31, nr 19, s. 1592-1597Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose. To assess the relationship between participation and problems with participation in life situations, and life satisfaction in persons with late effects of polio. Methods. One hundred fifty-eight persons with late effects of polio responded to a postal questionnaire including the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA-S) and Life Satisfaction Questionnaire (LiSat-11). Results. The persons' perceived participation in the five domains of participation in the IPA-S was significantly correlated with their satisfaction with life as a whole and with most of the 10 domains of life satisfaction. Significant differences in satisfaction with life as a whole and with eight of the 10 domains in LiSat-11 were found between groups of increasing severe problems with participation. Greater number of reports of severe problems with participation corresponded with gradually decreased satisfaction with life as a whole and with satisfaction in the eight domains in LiSat-11. Conclusions. Perceived participation and problems with participation in life situations are determinants of life satisfaction in persons with late effects of polio. This implies that addressing participation and problems with participation in the rehabilitation of persons with late effects of polio may lead to an enhanced life satisfaction.

  • 61.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lövgren-Engström, Ann-Louice
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Lexell, Jan
    Response actions to difficulties in using everyday technology after acquired brain injury2012Inngår i: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 19, nr 2, s. 164-175Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: People with acquired brain injury (ABI) have difficulties using everyday technology (ET) in daily tasks at home and in society. To support them in managing the demands imposed by using ET, knowledge is needed concerning their response actions to the difficulties. The aim of this study was to explore and describe what characterizes response actions to difficulties using ET, their conditions, and how they influence the experiences of tasks in daily life among people with ABI. Methods: Interviews and observations were undertaken with 13 persons with an ABI. Data were analysed qualitatively using the constant comparative method. Results: The participants' response actions were categorized as (i) deliberate and organized planning, (ii) random and inflexible repeating (iii), re-evaluating tasks, (iv) explaining difficulties related to others, and (iv) proving and protecting capability. Certain conditions were decisive for the different response actions to be applied and also for their effectiveness in enabling engagement in tasks in daily life. Each participant used several types of response actions and the same action could be applied in several situations. Conclusion: To support people with an ABI to manage the demands imposed by using ET, it is important to identify the uniqueness of each client and his or her response actions to difficulties using ET and thereafter adjust the interventions accordingly.

  • 62.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Lövgren-Engström, Ann-Louice
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Using everyday technology to compensate for difficulties in task performance in daily life: Experiences in persons with acquired brain injury and their significant others2011Inngår i: Disability and Rehabilitation: Assistive Technology, ISSN 1748-3107, E-ISSN 1748-3115, Vol. 6, nr 5, s. 402-411Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose. The purpose of this study is to illuminate how persons with acquired brain injury (ABI) and their significant others experienced individualised occupation-based interventions using commonly available everyday technology (ET) to compensate for perceived difficulties with performance of tasks in daily life. Method. Qualitative research interviews were conducted with 10 persons with ABI and with one of their significant others. The data were analysed according to qualitative content analysis. Results. The persons with ABI experienced that they mastered their lives in a better way by the compensatory use of ET. They became capable of doing tasks independently and experienced themselves as being a new person. During the intervention process, persons with ABI became aware of the compensatory potential of familiar ET, and they were supported to use effective compensatory strategies and incorporate them into their habits. Their significant others felt a relief in daily life, and their mood was positively affected as they experienced reduced responsibility and need of control. Conclusions. This qualitative study has shown that persons with ABI, as well as their significant others, experienced a multitude of benefits from occupation-based interventions using commonly available ET to compensate for their difficulties in the performance of tasks in daily life and that the goals achieved affected their overall contentment with life

  • 63.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Nordlund, Anders
    Bernspång, Birgitta
    Institutionen för samhällsmedicin och rehabilitering, Umeå universitet.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Perceived participation and problems in participation are determinants of life satisfaction in people with spinal cord injury2007Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 29, nr 18, s. 1417-1422Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose. To determine the relationships between perceived participation and problems in participation, and life satisfaction in people with spinal cord injury (SCI). Method. A total of 157 men and women with SCI completed the Swedish versions of the Impact on Participation and Autonomy Questionnaire (IPA) and the Life Satisfaction Questionnaire (LiSat-9). Results. The respondents' perceived participation in the five domains of the IPA was significantly correlated with their satisfaction with life as a whole (P < 0.01) and in most of the eight other domains of life satisfaction (P < 0.05 to P < 0.01) in the LiSat-9. The respondents' life satisfaction decreased gradually with increasing frequency of severe problems in participation and significant differences within groups of increasingly severe problems were found. The level of life satisfaction in respondents that perceived no severe problems with participation was similar to those of a normal population. Conclusions. Perceived participation and problems in participation are determinants of life satisfaction in people with SCI. The results emphasize the importance to focus on severe problems with participation in order to optimize life satisfaction during the rehabilitation after SCI.

  • 64.
    Larsson-Lund, Maria
    et al.
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Nordlund, Anders
    Nygård, Louise
    Karolinska institutet, Divison of occupational therapy. Department of Neurotec.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap.
    Bernspång, Birgitta
    Umeå University, Department of Community Medicine and Rehabilitation, Occupational Therapy.
    Perceptions of participation and predictors of perceived problems with participation in persons with spinal cord injury2005Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, nr 1, s. 3-8Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To describe how persons with spinal cord injury perceived their participation in life situations and to determine the relationship between their participation and perceived problems therewith. The purpose was also to evaluate the influence of age, sex, level of injury, time since injury, marital status and access to social support on perceived problems with participation. Design: Cross-sectional. Subjects: One hundred sixty-one persons with spinal cord injury. Methods: A postal questionnaire including socio-demographic characteristics and a Swedish version of the Impact on Participation and Autonomy questionnaire. Results: A majority of the respondents perceived their participation as sufficient in most activities addressed. Still, a majority of the respondents perceived one or more severe problems with their participation. Access to social support was the most influencing variable in predicting perceived severe problems with participation as compared with certain personal and health-related factors. Conclusion: The results suggest that it is important to consider access to social support along with other factors in the person-environment interaction and their influence on severe problems with participation in enhancing clients' participation in rehabilitation.

  • 65.
    Laskowski, Edward R.
    et al.
    Mayo Clinic Sports Medicine Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic.
    Lexell, Jan
    Exercise and sports for health promotion, disease, and disability2012Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, nr 11, s. 795-796Artikkel i tidsskrift (Fagfellevurdert)
  • 66.
    Lexell, Eva Månsson
    et al.
    Department of Rehabilitation Medicine, Skåne University Hospital.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Larsson-Lund, Maria
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    The rehabilitation plan can support clients’ active engagement and facilitate the process of change: experiences from people with late effects of polio participating in a rehabilitation programme2016Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 38, nr 4, s. 329-336Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To explore how the rehabilitation plan influences the rehabilitation process and its outcome in people with late effects of polio participating in an individualised goal-oriented interdisciplinary rehabilitation programme. Methods: Four women and two men with late effects of polio were interviewed before rehabilitation, at discharge, and at follow-up. Data were analysed according to the constant comparative method of grounded theory. Findings: The participants’ experiences formed one core category: “The same starting point but different rehabilitation processes”. Before rehabilitation, all participants experienced a similar starting point: Naïve understanding of rehabilitation. During rehabilitation, two separate processes followed. Four participants experienced their rehabilitation as being a mutually shared process that led to a process of change. They were actively engaged, using the rehabilitation plan, and working towards goals targeting a broad perspective of daily activities. The remaining two participants experienced their rehabilitation as a staff-directed process, with limited use of the rehabilitation plan, focusing on goals mainly related to body functions and self-care, not leading to any substantial changes. Conclusion: When clients experience that they develop a mutually shared rehabilitation process, based on a rehabilitation plan, they became more engaged in their rehabilitation and gained a better understanding of their participation during the process. Knowledge of the differences in how clients use the rehabilitation plan during the rehabilitation process can support their active engagement during rehabilitation. This, in turn, can promote a more holistic view among clients and professionals during the rehabilitation for people with late effects of polio

  • 67. Lexell, Jan
    Ageing and human muscle: observations from Sweden1993Inngår i: Canadian Journal of Applied Physiology, ISSN 1066-7814, E-ISSN 1543-2718, Vol. 18, nr 1, s. 2-18Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The purposes of this review are to summarize studies of cross-sections of autopsied whole muscles from previously physically healthy males and to focus on the cause of the ageing atrophy. The ageing atrophy begins around 25 years of age and thereafter accelerates. This is caused mainly by a loss of muscle fibres, and to a lesser extent by a reduction in fibre size, mostly of the proportion of the fibre area in the muscle cross-section occupied by type 2 (fast-twitch) fibres. In muscle from old subjects, there is a significant increase in the number of enclosed fibres, indicating an increased incidence of fibre type grouping, a loss of motor neurons in the spinal cord, and a reduction in the number of functioning motor units. These findings strongly suggest a combination of a progressive denervation process and an altered physical activity level as the two major mechanisms underlying the effects of normal ageing on human muscle. These changes have obvious implications for old individuals and their participation in physical activity and in sports, which must be accommodated in rehabilitation regimes or in training programmes.

  • 68.
    Lexell, Jan
    Luleå tekniska universitet, Institutionen för hälsovetenskap, Hälsa och rehabilitering.
    Aktivitet: Elektroniskt teknikstöd, vardagsteknologi och kognition2006Konferansepaper (Annet (populærvitenskap, debatt, mm))
  • 69. Lexell, Jan
    Distribution of different fibre types in human skeletal muscles1985Doktoravhandling, med artikler (Annet vitenskapelig)
  • 70. Lexell, Jan
    Effekter av styrke- och uthållighetsträning på skelettmuskulaturen hos äldre: Gamla muskler blir som nya!1999Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, nr 3, s. 207-9Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    A well-known effect of increasing age is the gradual reduction of muscle function, and thus of performance in the activity of daily living. Recent research has shown that, even among the very elderly, exercise can improve not only strength and endurance, but also balance and mobility, thus reducing the risk of falls. The possibility of counteracting some of the age-related muscle changes has also been demonstrated. The article reviews current knowledge of strength and endurance training in the elderly, the importance of exercise to improve physical performance, and how lifelong exercise can counteract the effects associated with the ageing of the neuromuscular system

  • 71. Lexell, Jan
    Epilepsi2000Inngår i: Svensk rehabilitering, ISSN 1403-4468, nr 3, s. 15-16Artikkel i tidsskrift (Annet vitenskapelig)
  • 72. Lexell, Jan
    Evidence for nervous system degeneration with advancing age1997Inngår i: Journal of Nutrition, ISSN 0022-3166, E-ISSN 1541-6100, Vol. 127, nr 5 suppl, s. 1011S-1013SArtikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Human skeletal muscle undergoes major structural and functional changes with advancing age. A progressive degeneration of the nervous system is now considered a major factor underlying these alterations. This review will briefly describe the changes that occur in the human motor unit with increasing age and focus specifically on the changes that relate to a degeneration of the nervous system.

  • 73. Lexell, Jan
    Fysisk aktivitet och träning hos funktionshindrade: Effekter på aktivitetsförmåga och livstillfredsställelse2004Inngår i: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 13, nr 2, s. 4-7Artikkel i tidsskrift (Annet vitenskapelig)
  • 74. Lexell, Jan
    Gamla muskler blir som nya!2000Inngår i: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 9, nr 4, s. 27-9Artikkel i tidsskrift (Annet vitenskapelig)
  • 75. Lexell, Jan
    Gamla muskler blir som nya! Muskelträning kan ge effekt även hos 90-åringar2000Inngår i: I Vaarden, ISSN 1403-2082, nr 1, s. 26-29Artikkel i tidsskrift (Annet vitenskapelig)
  • 76. Lexell, Jan
    Human aging, muscle mass, and fiber type composition1995Inngår i: The journals of gerontology. Series A, Biological sciences and medical sciences, ISSN 1079-5006, E-ISSN 1758-535X, Vol. 50, nr Spec No, s. 11-16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    To assess the age-related loss of muscle mass and to determine the mechanisms behind this aging atrophy, the muscle structure and fiber type composition have been estimated, using invasive and noninvasive techniques. Limb muscles from older men and women are 25-35% smaller and have significantly more fat and connective tissue than limb muscles from younger individuals. Comparisons of muscle biopsies from younger and older individuals reveal that type 2 (fast-twitch) fibers are smaller in the old, while the size of type 1 (slow-twitch) fibers is much less affected. Studies of whole muscle cross sections also show a significantly smaller number of muscle fibers, a significantly lower relative type 2 fiber area, and a significant increase in fiber type grouping with increasing age. These results indicate a gradual decrease in size/volume with advancing age, accompanied by a replacement by fat and connective tissue. This aging atrophy seems to be due to a reduction in both number and size of muscle fibers, mainly of type 2, and is to some extent caused by a slowly progressive neurogenic process

  • 77. Lexell, Jan
    Hård kritik mot sportdrycker1995Inngår i: Svensk idrottsmedicin, ISSN 1103-7652, Vol. 14, nr 6, s. 27-Artikkel i tidsskrift (Annet vitenskapelig)
  • 78. Lexell, Jan
    International programs and perspectives2007Inngår i: The journal of head trauma rehabilitation, ISSN 0885-9701, E-ISSN 1550-509X, Vol. 22, nr 4, s. 213-Artikkel i tidsskrift (Annet vitenskapelig)
  • 79. Lexell, Jan
    Kronisk neurologisk sjukdom2002Inngår i: Svensk rehabilitering, ISSN 1403-4468, nr 4, s. 7-11Artikkel i tidsskrift (Annet vitenskapelig)
  • 80. Lexell, Jan
    Lund visar musklerna med nytt laboratorium1995Inngår i: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 4, nr 3, s. 9-12Artikkel i tidsskrift (Annet vitenskapelig)
  • 81. Lexell, Jan
    Motionera - så trivs du bättre på jobbet1988Inngår i: Idrottsmedicin, ISSN 0280-5820, Vol. 8, nr 4, s. 18-Artikkel i tidsskrift (Annet vitenskapelig)
  • 82. Lexell, Jan
    Multiple skleros. Leder rehabilitering till förbättringar?1999Inngår i: Svensk rehabilitering, ISSN 1403-4468, Vol. 1, nr 2, s. 30-31Artikkel i tidsskrift (Annet vitenskapelig)
  • 83. Lexell, Jan
    Muscle capillarization: morphological and morphometrical analyses of biopsy samples1997Inngår i: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 5, nr Supplement, s. S110-S112Artikkel i tidsskrift (Fagfellevurdert)
  • 84. Lexell, Jan
    Muscle structure and function in chronic neurological disorders: The potential of exercise to improve activities of daily living.2000Inngår i: Exercise and sport sciences reviews, ISSN 0091-6331, E-ISSN 1538-3008, Vol. 28, nr 2, s. 80-84Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Our knowledge of muscle function in chronic neurological disorders, the effects of exercise, and how the effects might translate into improvements in activities of daily living is very limited. By building a bridge between basic muscle physiology and clinical rehabilitation, our knowledge of the pathophysiological mechanisms underlying muscle dysfunction in people with chronic neurological disorders will increase. This will facilitate the design and subsequent evaluation of exercise programs for these people and improve our understanding of the effects of such interventions on performance of activities of daily living

  • 85. Lexell, Jan
    Parkinsons sjukdom2000Inngår i: Svensk rehabilitering, ISSN 1403-4468, nr 3, s. 31-Artikkel i tidsskrift (Annet vitenskapelig)
  • 86. Lexell, Jan
    Parkinsons sjukdom och rehabilitering2000Bok (Annet (populærvitenskap, debatt, mm))
  • 87. Lexell, Jan
    Postpolio rehabilitering: När brukarna själva får vara med och bestämma2005Inngår i: Svensk rehabilitering, ISSN 1403-4468, Vol. 7, nr 1, s. 22-26Artikkel i tidsskrift (Annet vitenskapelig)
  • 88. Lexell, Jan
    Rehabilitation of traumatic brain injuries in sweden2007Inngår i: The journal of head trauma rehabilitation, ISSN 0885-9701, E-ISSN 1550-509X, Vol. 22, nr 4, s. 229-33Artikkel i tidsskrift (Fagfellevurdert)
  • 89. Lexell, Jan
    Styrketräning för äldre2001Inngår i: Svensk Idrottsforskning: Organ för Centrum för Idrottsforskning, ISSN 1103-4629, Vol. 10, nr 3, s. 34-7Artikkel i tidsskrift (Annet vitenskapelig)
  • 90. Lexell, Jan
    Styrketräning för äldre1992Inngår i: Idrottsmedicin, ISSN 0280-5820, Vol. 11, nr 3, s. 6-Artikkel i tidsskrift (Annet vitenskapelig)
  • 91. Lexell, Jan
    TWAR - vad vet vi idag?1993Inngår i: Svensk idrottsmedicin, ISSN 1103-7652, Vol. 12, nr 1, s. 10-11Artikkel i tidsskrift (Annet vitenskapelig)
  • 92. Lexell, Jan
    What's on the Horizon: Defining Physiatry Through Rehabilitation Methodology2012Inngår i: PM&R, ISSN 1934-1482, E-ISSN 1934-1563, Vol. 4, nr 5, s. 331-334Artikkel i tidsskrift (Annet vitenskapelig)
  • 93. Lexell, Jan
    et al.
    Bellner, J
    Department of Neurosurgery, Lund University Hospital.
    Jensen, S-M
    Department of Neurosurgery, Lund University Hospital.
    Romner, Bertil
    Department of Neurosurgery, Lund University Hospital.
    Diagnostic criteria and the use of ICD-10 codes to define and classify minor head injury.2003Inngår i: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 74, nr 3, s. 351-2Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Epidemiological research on the incidence of traumatic head injuries relies on the correct definition and classification of the injury. OBJECTIVE: To address the use of diagnostic criteria and ICD-10 codes to define minor head injury in Swedish hospitals managing patients with head injury. METHODS: A questionnaire was mailed to all 76 Swedish hospitals managing head injuries. The hospitals were asked what diagnostic criteria they use to define minor head injury, and which ICD-10 codes they use to classify such injuries. RESULTS: 72 hospitals (95%) responded to the survey. The most common criterion was loss of consciousness (76%), followed by post-traumatic amnesia (38%). Almost half the hospitals used other signs and symptoms to define minor head injury. The ICD-10 code S.06 (intracranial injury) was used by 51 of the hospitals (91%). CONCLUSIONS: It is essential that there should be common definitions, classifications, and registration of minor head injuries. The wide variation in definition and classification found in this study emphasises the importance of improved implementation of the present guidelines.

  • 94. Lexell, Jan
    et al.
    Brogårdh, Christina
    Institutionen för hälsa, vård och samhälle, Lunds universitet.
    Fysiologiska förändringar hos äldre och effekter av träning2012Inngår i: Äldres hälsa: ett sjukgymnastiskt perspektiv, Lund: Studentlitteratur AB, 2012, s. 19-29Kapittel i bok, del av antologi (Annet (populærvitenskap, debatt, mm))
  • 95. Lexell, Jan
    et al.
    Brogårdh, Christina
    Department of Rehabilitation Medicine, Skåne University Hospital.
    Life satisfaction and self-reported impairments in persons with late effects of polio2012Inngår i: Annals of Physical and Rehabilitation Medicine, ISSN 1877-0657, E-ISSN 1877-0665, Vol. 55, nr 9-10, s. 577-589Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: Decades after an acute poliomyelitis infection many persons experience new symptoms or impairments which may affect their life satisfaction. The objective of this study was to investigate the association between life satisfaction and self-reported impairments in persons with late effects of polio. Material and methods: One hundred and sixty-nine persons (104. women and 65. men) with prior polio responded on admission to rehabilitation to the Life Satisfaction Questionnaire (LiSat-11) assessing satisfaction with life as a whole and 10 domains of life satisfaction and to a 13-item questionnaire assessing self-reported impairments related to late effects of polio. Results: A majority was to some degree satisfied with life as a whole and with all 10 domains of life satisfaction in LiSat-11, but less than 20% was very satisfied or satisfied with their somatic health. Muscle fatigue, muscle weakness, general fatigue, muscle and/or joint pain during physical activity and cold intolerance were the most frequently reported impairments. Overall, those who rated themselves as not satisfied (according to LiSat-11) reported significantly higher degrees of impairment than those who were satisfied. The relationships between the items of life satisfaction in LiSat-11 and the items in the self-report questionnaire varied from -0.01 to -0.64. Conclusion: Satisfaction with life as a whole, and different domains of life satisfaction are low to moderately associated with self-reported impairments. This implies that rehabilitation interventions must address not only self-reported impairments but also activity limitations and participation restrictions in order to enhance life satisfaction in people with late effects of polio

  • 96. Lexell, Jan
    et al.
    Downham, David
    Department of Statistics & Computational Mathematics, University of Liverpool.
    The occurrence of fibre-type grouping in healthy human muscle: a quantitative study of cross-sections of whole vastus lateralis from men between 15 and 83 years1991Inngår i: Acta Neuropathologica, ISSN 0001-6322, E-ISSN 1432-0533, Vol. 81, nr 4, s. 377-381Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Methods that objectively assess the muscle fibre-type arrangement may improve the detection of fibre-type grouping, a diagnostic sign of a denervation and reinnervation process. To distinguish between a diseased and a normal muscle, there is a need for quantitative data on the fibre-type arrangement in healthy human muscles at different ages. In this study, cross-sections were prepared of whole autopsied vastus lateralis muscle from 24 previously physically healthy men, aged 15 to 83 years. The arrangements of type 1 and type 2 fibers were assessed in terms of the number of enclosed fibres in individual fascicles throughout each muscle. Recent improvements to the enclosed fibre method were used to define measures of randomness which facilitated the combination of several sample areas and the quantification of the fibre-type arrangements. Segregation was typical for young muscles, randomness was most common between 30 and 50 years of age, while some fibre-type grouping was considered "normal" in old muscles. The arrangements of type 1 and type 2 fibres were quantitatively similar, irrespective of the age of the individual. The results imply that the fibre population changes considerably during a lifetime, and that it undergoes a continuous denervation and reinnervation process with normal ageing. Because of its importance, age should be accommodated in the analysis of a muscle sample, irrespective of the statistical model and method used

  • 97. Lexell, Jan
    et al.
    Downham, David
    Department of Statistics & Computational Mathematics, University of Liverpool.
    What determines the muscle cross-sectional area?1992Inngår i: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 111, nr 1, s. 113-114Artikkel i tidsskrift (Annet vitenskapelig)
  • 98. Lexell, Jan
    et al.
    Downham, David
    Department of Statistics & Computational Mathematics, University of Liverpool.
    What is the effect of ageing on type 2 muscle fibres?1992Inngår i: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 107, nr 2, s. 250-251Artikkel i tidsskrift (Annet vitenskapelig)
  • 99. Lexell, Jan
    et al.
    Downham, David
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Larsson, Y
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Bruhn, E
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Morsing, B
    Department of Rehabilitation, Lund University Hospital, Sweden.
    Heavy-resistance training in older Scandinavian men and women: short- and long-term effects on arm and leg muscles.1995Inngår i: Scandinavian Journal of Medicine and Science in Sports, ISSN 0905-7188, E-ISSN 1600-0838, Vol. 5, nr 6, s. 329-41Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The short- and long-term effects of heavy-resistance training (85% of one-repetition maximum (RM)) on elbow flexion and knee extension dynamic and isokinetic strength and on morphology in the biceps brachii and vastus lateralis muscles were evaluated during 1 year in 35 Scandinavian men and women, aged 70-77 years, 12 of whom formed a control group. After the first 11 weeks of training (n = 23; 3 times/week) elbow flexion and knee extension dynamic strength (1 RM) had increased [mean +/- SD] 49% +/- 16 and 163% +/- 75, respectively, with no significant difference between men and women. For the following 27 weeks, strength was maintained with one training session per week (n = 12) but dropped without training (n = 11). After the final 11 weeks of training (n = 11; 3 times/week), strength had further increased 32% +/- 16 in both the arm and the leg. Isokinetic strength measurements (Cybex II; 30 degrees/s) revealed similar but smaller gains than for dynamic strength. Muscle biopsies (n = 20) taken at the start and after the first 11 weeks of training showed a significant increase in the area of both type 1 and type 2 fibers in the biceps brachii muscle and a positive significant correlation between the percentage increase in the proportional area of type 2 fibers in the vastus lateralis muscle and the percentage increase in knee extension dynamic muscle strength. In conclusion, older Scandinavian men and women have a high capacity both to improve and to maintain muscle strength, some of which is mediated through an adaptation in the muscle fiber type population.

  • 100. Lexell, Jan
    et al.
    Downham, David
    Department of Mathematical Sciences, University of Liverpool.
    Miller, Michael
    Department of Physiotherapy, Lund University.
    Superimposed single impulse and pulse train electrical stimulation: A quantitative assessment during submaximal isometric knee extension in young, healthy men.1999Inngår i: Muscle and Nerve, ISSN 0148-639X, E-ISSN 1097-4598, Vol. 22, nr 8, s. 1038-1046Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Superimposed electrical stimulation techniques can be used to detect central activation failure (CAF), defined as incomplete central nervous system recruitment, suboptimal activation of motor units, or both. The purpose of this study was to evaluate superimposed electrical stimulation techniques to be used to detect CAF during isometric knee extension. We performed three sets of experiments and compared the torque increments from transcutaneous electrical stimulation with: (i) single impulses of different amplitudes (100 V, 150 V, and 200 V) and a pulse train of 100 Hz (100 V, 100 ms); (ii) pulse trains (100 Hz, 100 V) of different lengths (100 ms, 200 ms, and 300 ms); and (iii) pulse trains (100 Hz, 100 ms) of different amplitudes (50 V, 100 V, 150 V, and 200 V). Stimulation was evaluated at submaximal (80% of MVC) isometric knee extension in 24 healthy young men using a Biodex isokinetic dynamometer. Electrodes were placed over the rectus femoris muscle and all stimulation impulses were monophasic, rectangular waves of 0.2-ms duration. Pulse train stimulation at 100 V always elicited a torque increment, whereas single impulse stimulation, even at 200 V, only caused a torque increment in about half of the trials. For each subject, the pulse train generated a significantly larger torque increment than for any of the three single impulses. There was no significant difference in torque increment between the three pulse trains of different lengths. Pulse trains at 150 V and 200 V generated significantly larger torque increments than at 50 V and 100 V. High-frequency maximal train stimulation may thus improve the detection of CAF during isometric knee extension. Detection of CAF may be important in the clinical assessment of muscle weakness, investigating the mechanisms underlying muscle weakness, and evaluating potential therapeutic strategies.

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