To Örebro University

Persons with neurological diseases often have some degree of cognitive impairment. They are in need of assistive technology for cognition (ATC) to compensate for cognitive impairments that affect their daily functioning. Goal setting in relation to cognitive deficits using ATC are common in clinical practice, and therapists often set several rehabilitation goals together with a patient. However, these rehabilitation goals are usually phrased differently, which limit the comparison of ATC and rehabilitation goals. It is thus valuable to link the goals to some standardized terminologies, such as the International Classification of Functioning, Disability and Health (ICF). Furthermore, goal achievement is seldom used to evaluate long-term effects of ATC in persons with neurological diseases and limited attention has been paid to the factors that predict goal achievement in using the ATC as cognitive support in persons with neurological diseases. The aim of the project is 3-fold. Firstly, we will use the ICF to link rehabilitation goals regarding the use of ATC in adults with neurological diseases. Secondly, we will evaluate effects of the ATC using goal achievement over a 5-year period. Thirdly, we will explore the variables that predict goal achievement in relation to the effects of ATC.

BACKGROUND: Low dexterity of conventional two-function (open, close) myoelectric hand prostheses with limited wrist movement often leads to compensatory shoulder and elbow movements, e.g. excess shoulder abduction and elbow flexion. Compensatory movements may lead to musculoskeletal pain [1] and it is thus important to identify prosthesis users with compensatory movements and to develop preventive treatments for musculoskeletal pain.

AIM: The study aim was to measure and compare compensatory movements during activity performance among upper limb prosthesis users with different levels of myoelectric control.

METHOD: Twenty-seven users of conventional myoelectric hand prosthesis performed the Assessment of Capacity for Myoelectric Control (ACMC) at the Örebro Limb Deficiency and Arm Prosthesis Centre. The performances were recorded and analyzed with Dartfish motion capture video analysis software. The software was used to track and measure the maximum angles for shoulder abduction and elbow flexion at the non-prosthetic and prosthetic sides during the activity performance. Two independent raters used Dartfish to analyze 10 videos and Intra-class Correlation Coefficient (ICC) was used to calculate inter-rater reliability. The ability to control a myoelectric prosthetic hand was assessed by the ACMC.

RESULTS: The within-individual differences for shoulder abduction ranged from 2° to 52° and for elbow flexion from 1° to 66°. When compared between prosthetic and non-prosthetic side, larger differences in shoulder abduction and elbow flexion were found among the users with ACMC ≤ 0 than users with ACMC > 0 (Fig.1a). When comparing the within-individual side differences between prosthesis users with ACMC ≤0 and users with ACMC >0, a significant angle difference was found in the elbows (p=0.03) but not in the shoulders (p=0.34) (Fig.1b). Inter-rater reliability between the two independent raters was excellent (ICC 0.91).

DISCUSSION AND CONCLUSION: Compensatory elbow movements during activity performance are higher in upper limb prosthesis users with low level of myoelectric control. Prevention for musculoskeletal pain should consist of both training for improved prosthetic control and improved prosthetic use in activity performance. Measurement of compensatory movements can help to identify amputees with frequent compensatory movements. Future studies are needed to investigate the effect of ability to control myoelectric prosthesis on musculoskeletal pain.

REFERENCES [1] Jones LE, Davidson JH. Prosthet Orthot Int 1999; 23(1):55-8.

ACKNOWLEDGEMENTS This study was supported financially by the Norrbacka-Eugenia Foundation.

The purpose of this classic grounded theory study was to understand how seniors who are living independently resolve issues influenced by visual impairment and high fall risk. We interviewed and observed 13 seniors with visual impairment in their homes. We also interviewed six visual instructors with experience from many hundreds of relevant incidents from the same group of seniors. We found that the seniors are resolving their main concern of ‘‘remaining themselves as who they used to be’’ by self-preservation. Within this category, the strategies maintaining the established self and defying deterioration emerged as the most prominent in our data. The theme maintaining the established self is mostly guided by change inertia and includes living the past (retaining past activities, reminiscing, and keeping the home intact) and facading (hiding impairment, leading to avoidance of becoming a burden and to risk juggling). Defying deterioration is a proactive scheme and involves moving (by exercising, adapting activities, using walking aids, driving), adapting (by finding new ways), and networking by sustaining old support networks or finding new networks. Self-preservation is generic human behavior and modifying this theory to other fields may therefore be worthwhile. In addition, health care providers may have use for the theory in fall preventive planning.

Perceived vision-related quality of life and risk of falling among community living elderly people Falls and fall injuries among the elderly population are common, since ageing is a risk factor of falling. Today, this is a major problem because the ageing population is increasing. There are predictive factors of falling and visual impairment is one of them. Usually, only visual acuity is considered when measuring visual impairment, and nothing regarding a person's functional visual ability is taken into account. Therefore, the aim of this study was to assess the perceived vision-related quality of life among the community living elderly using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and to investigate whether there was any association among vision-related quality of life and falls. There were 212 randomly selected elderly people participating in the study. Our study indicated that the participants had an impaired perceived vision-related health status. General health was the only NEI VFQ-25 variable significantly associated with falls in both men and women. However, among men, near and distance activities, vision-specific social functioning, role difficulties and dependency, color and peripheral vision were related to falls.

Background: Falls and fall injuries among the elderly population is an important public health issue today since ageing is an independent risk factor of falling and because of an increasing elderly population. Falls and fall injuries are associated with high healthcare costs but also considerable suffering for the individual. According to the Swedish National Health Institute the costs of deterioration in quality of life caused by accidental falls are calculated to be twice as high as the direct costs such as medical treatment, healthcare and rehabilitation. There are various predictive factors of falling and visual impairment isone of them. It is well known that visual impairment occurs increasingly as people age. Usually, only visual acuity is considered when measuring visual impairment, but nothing regarding a person’s functional visual ability is taken into account.

Methods: Therefore, the aim of our study was to assess the perceived vision-targeted health status among non-institutionalized elderly living in the community using the 25-item National Eye Institute Visual Function Questionnaire (NEI VFQ-25) and to investigate whether there was any association between the vision-targeted health status and falls. There were 212 randomly selected elderly participants in the study.

Results: The results showed that general health was the only variable significantly associated with falls both among men (p = 0.011) and women (p = 0.029). However, among men, distance activities (p = 0.033), such as going down steps, or curbs in dim light, and peripheral vision (p = 0.048) such as difficulties in noticing objects off to the side while walking along, were significantly associated with falling. Near activities (p = 0.005), color vision (p = 0.002) and dependency (p = 0.022) as well as social functioning (p = 0.014) and role difficulties (p = 0.000) were also significantly associated with falling among men.

Conclusions: To meet the demands from an increasing elderly population, a more holistic approach of the visual function is needed when identifying elderly individuals at risk of falling.

The objective was to evaluate changes after a two half-day patient transfer course regarding nursing staffs movement and body awareness, attitudes, reported behaviour, strain, disorder and sick leave. The course aimed at increasing staffs self-awareness of movements and body, and their communication competence, with the intention to promote the patient’s independent mobility. Ninety-nine staff in an intervention group and 77 staff in two control groups answered a questionnaire before and after the intervention. After one year there was a significant increase in the number of instructions given and nursing staff’s movement awareness in the intervention group compared to the control group. Reported physical disorders decreased significantly in the intervention group compared with both control groups. Increased movement awareness and frequent use of instructions during transfers may encourage patients to move independently and thereby reduce the strain in nursing staff.

The objective was to explore and describe nursing staff's body awareness and communication in patient transfers and evaluate any changes made after an educational intervention to promote staff competence in guiding patients to move independently. In total, 63 nursing staff from two hospitals wrote weekly notes before and after the intervention. The topics were: A) reflect on a transfer during the last week that you consider was good and one that was poor; B) reflect on how your body felt during a good and a poor transfer. The notes were analysed with content analysis. The results showed five different communication modes connected with nursing staff's physical and verbal communication. These communication modes changed after 1 year to a more verbal communication, focusing on the patient's mobility. The use of instructions indicated a new or different understanding of patient transfer, which may contribute to a development of nursing staff's competence. Statement of Relevance: The present findings indicate that patient transfer consists of communication. Therefore, verbal and bodily communication can have an integral part of training in patient transfer; furthermore, the educational design of such programmes is important to reach the goal of developing new understanding and enhancing nursing staff's competence in patient transfer.

Background and aims: Pain-related fear and catastrophizing are prominently related to acute and persistent back pain, but little is known about their role in pain and function after a fracture. Since fractures have a clear etiology and time point they are of special interest for studying the process of recovery. Moreover, fracture injuries are interesting in their own right since patients frequently do not recover fully from them and relatively little is known about the psychological aspects. We speculated that catastrophizing and fear-avoidance beliefs might be associated with more pain and poorer recovery after an acute, painful fracture injury.

Methods: To this end we conducted a prospective cohort study recruiting 70 patients with fractures of the wrist or the ankle. Participants completed standardized assessments of fear, pain, catastrophizing, degree of self-rated recovery, mobility and strength within 24 h of injury, and at 3- and 9-month follow-ups. Participants were also categorized as having high or low levels of fear-avoidance beliefs by comparing their scores on the first two assessments with the median from the general population. To consolidate the data the categorizations from the two assessments were combined and patients could therefore have consistently high, consistently low, increasing, or decreasing levels.

Results: Results indicated that levels of fear-avoidance beliefs and catastrophizing were fairly low on average. At the first assessment 69% of the patients expected a full recovery within 6 months, but in fact only 29% were fully recovered at the 9-month follow-up. Similarly, comparisons between the affected and non-affected limb showed that 71% of those with a wrist fracture and 58% with an ankle fracture were not fully recovered on grip strength and heel-rise measures. Those classified as having consistently high or increasing levels of fear-avoidance beliefs had a substantially increased risk of more intense future pain (adjusted OR = 3.21). Moreover, those classified as having consistently high or increasing levels of catastrophizing had an increased risk for a less than full recovery of strength by almost six-fold (adjusted OR = 5.87).

Conclusions and implications: This is the first investigation to our knowledge where the results clearly suggest that fear and catastrophizing, especially when the level increases, may be important determinants of recovery after an acute, painful, fracture injury. These results support the fear-avoidance model and suggest that psychological factors need to be considered in the recovery process after a fracture.

Objective. To examine and compare levels of catastrophizing, fear-avoidance beliefs, physical ability, and health-related quality of life in women with and without lumbopelvic pain (LP and NLP) in early pregnancy. Design. A cross-sectional study of early pregnancy. Setting. Five midwife clinics, one in the center, two in the outskirts of Stockholm, and two in a medium-sized town. Population. Three hundred and twenty-four women in the 19th-21st week of pregnancy. Methods. Questionnaires. Main outcome measures. The Pain Catastrophizing Scale of exaggerated negative thoughts about pain experiences, the Fear-Avoidance Beliefs Questionnaire of beliefs about how physical activity and work affect back pain, the Disability Rating Index of physical ability, and the Nottingham Health Profile to assess health-related quality of life. Results. Two groups were defined: LP (n=141) and NLP (n=183). The Mann-Whitney U-test was used for comparisons. Pregnant women with LP had significantly (p0.05) higher levels of exaggerated negative thoughts and fear-avoidance beliefs. They also had lower physical ability and health-related quality of life compared to women in the NLP group. Conclusions. It is important to consider exaggerated negative thoughts about pain experiences and fear-avoidance beliefs when treating women with LP during pregnancy and to be aware of the great impact lumbopelvic pain has on women's lives during early pregnancy.

Fear-avoidance beliefs and catastrophizing have been shown to be powerful cognitions in the process of developing chronic pain problems and there is a need for increased knowledge in early stages of pain.

The objectives of this study were therefore, firstly, to examine the occurrence of fear-avoidance beliefs and catastrophizing in groups with different degrees of non-chronic spinal pain in a general population, and secondly to assess if fear-avoidance beliefs and catastrophizing were related to current ratings of pain and activities of daily living (ADL).

The study was a part of a population based back pain project and the study sample consisted of 917 men and women, 35-45 years old, either pain-free or with non-chronic spinal pain. The results showed that fear-avoidance beliefs as well as catastrophizing occur in this general population of non-patients. The levels were moderate and in catastrophizing a 'dose-response' pattern was seen, such that more the catastrophizing was, the more was pain. The study showed two relationships, which were between fear-avoidance and ADL as well as between catastrophizing and pain intensity. Logistic regression analyses were performed with 95% confidence intervals and the odds ratio for fear-avoidance beliefs and ADL was 2.5 and for catastrophizing and pain 1.8, both with confidence interval above unity. The results suggest that fear-avoidance beliefs and catastrophizing may play an active part in the transition from acute to chronic pain and clinical implications include screening and early intervention. (C) 2002 International Association for the Study of Pain. Published by Elsevier Science B.V. All rights reserved.