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Hensikten med denne fagartikkelen er å belyse helsefagarbeideres erfaringer med deres nye rolle som «hjemmetrenere» i hverdagsrehabiliteringsteam. Åtte helsefagarbeidere fra seks fylker ble intervjuet. Resultatene viser at overgangen fra å være en tradisjonell «hjelper» til å bli «trener» i hverdagsrehabilitering medførte en betydelig og utfordrende rolleendring. Avklaring av rolleforventninger var viktig for samspillet mellom hjemmetrener og bruker, spesielt knyttet til motiveringsarbeidet. I hverdagsrehabilitering ligger en forventning om deltakende og aktive eldre, og helsefagarbeidernes motiveringsarbeid innebærer en «dulting» av brukere mot en mer ønsket adferd. Helsearbeiderne uttrykte frustrasjon om manglende likestilling og anerkjennelse av egen fagkunnskap i det tverrfaglige teamet.

Background. Parkinson’s disease is a neurodegenerative condition with both physical and mental consequences that affect many aspects of everyday life. Persons with Parkinson’s disease and their care partners want guidance from healthcare services in order to develop skills to adjust to life with a long-term condition. The Swedish National Parkinson School is a dyadic self-management programme to support both persons with Parkinson’s disease and care partners. Objective. To assess the outcomes of the Swedish National Parkinson School as reported by participants. Design. A quasi-experimental case-control study in clinical care using self-reported questionnaires. Participants. Swedish National Parkinson School was offered by health care professionals working in clinical care. Participants in the programme were also asked to participate in the study. A matched control group was recruited for a comparison of findings. In total, 92 persons with Parkinson’s disease and 55 care partners were included. Settings. Five Swedish geriatric and neurologic outpatient clinics. Method. Data were collected during 2015–2017, before and after participation in the National Parkinson School or before and after seven weeks of standard care. Outcomes were assessed using generic and Parkinson’s specific questionnaires. Descriptive statistics were used to describe baseline characteristics. Mann–Whitney U and Chi2 tests were used to test for between-group differences and within-group differences were tested by the Wilcoxon signed-ranks test. Results. Improvements regarding health status, constructive attitudes and approaches, and skill and technique acquisition were found after the intervention among persons with Parkinson’s disease. No changes were found among care partners. Conclusion. The findings indicate that the Swedish National Parkinson School may improve health status and self-management among persons with Parkinson’s disease, but further studies are needed to better understand the effects of the programme.

Studien belyser tre kvinners opplevelser av at deres selvstendige ektefeller får slag og blir sterkt pleietrengende, samt hvordan de opplever samhandlingen med helse- og omsorgstjenesten. Det er benyttet en hermeneutisk- fenomenologisk tilnærming og semistrukturerte kvalitative intervju. Funnene viser at kvinnene opplever utmattelse, usikkerhet og hjelpeløshet i sin egen rolle som ektefelle, mor og omsorgsgiver, og føler at deres identitet er truet. Informasjonen fra den kommunale helse- og omsorgstjenesten oppleves som mangelfull og kvinnene føler seg satt på sidelinjen og avvist. De føler behov for støtte og omsorg og savner samtalepartnere de kan ha meningsskapende og relasjonsorientert kommunikasjon med. Den nye hverdagen påvirker kvinnenes helse, og over tid utvikler de stressrelaterte lidelser. Det å ha aktiviteter utenfor hjemmet, som jobb og fritidsinteresser, er en viktig mestringsstrategi for å takle den utfordrende livssituasjonen. Det er en tanke at utdanning og likestilling trår fram som en faktor i opprettholdelse av helse og livskvalitet. For å ivareta kvinnenes etterspørsel etter informasjon og oppfølging og styrke samhandlingen mellom brukerne, de pårørende og tjenesteyterne kan ordninger som koordinator, brukers individuelle plan og brukerstyrt personlig assistanse innarbeides som redskaper i det daglige helse- og omsorgsarbeidet.

Background. Hand functionality and finger dexterity are impaired in patients with Parkinson’s disease (PD). These disturbances lead to a dependency in activities of daily living (ADL) and poor quality of life (QoL). Objective. We aimed to evaluate whether a specific occupational therapy (OT) program is effective in improving finger and hand dexterity and its impact on ADL in PD patients. Methods. We retrospectively studied PD patients, hospitalized for a 4-week multidisciplinary intensive rehabilitation treatment (MIRT) between January 2015 and June 2018. All patients underwent 1 h/day OT treatment, 5 days a week. The primary outcome measure was the O’Connor finger dexterity test; secondary outcome measures were the Minnesota dexterity test, UPDRS II, and Self-Assessment Parkinson’s Disease Disability Scale (SPDDS). These measures were assessed at admission (T0) and discharge (T1). Results. Based on the Hoehn and Yahr scale (H&Y), patients were divided into two groups: 262 subjects in H&Y stage Conclusions. We showed that PD patients who underwent a rehabilitation protocol including OT experienced improvements in finger dexterity and hand functionality. Our results underline the relevance of OT in improving autonomy and QoL in PD patients.

Background and aim To report the six-month safety analyses among patients enrolled in the “Physical Fitness Training in Subacute Stroke—PHYS-STROKE” trial and identify underlying risk factors associated with serious adverse events. Methods We performed a pre-specified safety analysis of a multicenter, randomized controlled, endpoint-blinded trial comprising 200 patients with moderate to severe subacute stroke (days 5–45 after stroke) that were randomly assigned (1:1) to receive either aerobic, bodyweight supported, treadmill-based training (n = 105), or relaxation sessions (n = 95, control group). Each intervention session lasted for 25 min, five times weekly for four weeks, in addition to standard rehabilitation therapy. Serious adverse events defined as cerebro- and cardiovascular events, readmission to hospital, and death were assessed during six months of follow-up. Incident rate ratios (IRR) were calculated, and Poisson regression analyses were conducted to identify risk factors for serious adverse events and to test the association with aerobic training. Results Six months after stroke, 50 serious adverse events occurred in the trial with a higher incidence rate (per 100 patient-months) in the training group compared to the relaxation group (6.31 vs. 3.22; IRR 1.70, 95% CI 0.96 to 3.12). The association of aerobic training with serious adverse events incidence rates were modified by diabetes mellitus (IRR for interaction: 7.10, 95% CI 1.56 to 51.24) and by atrial fibrillation (IRR for interaction: 4.37, 95% CI 0.97 to 31.81). Conclusions Safety analysis of the PHYS-STROKE trial found a higher rate of serious adverse events in patients randomized to aerobic training compared to control within six months after stroke. Exploratory analyses found an association between serious adverse events occurrence in the aerobic training group with pre-existing diabetes mellitus and atrial fibrillation which should be further investigated in future trials. Data access statement The raw data and analyses scripts are provided by the authors on a secure online repository for reproduction of reported findings.

Purpose: The aim of this paper was to describe how people living with a neurological disability such as multiple sclerosis, Parkinson’s disease and stroke reason regarding using apps to facilitate self-management in everyday life.Material and methods: A qualitative research approach with a focus group methodology was used. The sample comprised 16 participants, 11 men and 5 women, with an average age of 64 years (ranging from 51–80 years). Six participants were diagnosed with multiple sclerosis, six with Parkinson’s disease and four with stroke. Data were analyzed using thematic analysis, which is a method for identifying, analyzing and reporting patterns.Results: The results formed two themes. The first theme “using apps to have control of my health” comprises two subthemes; “monitor and take responsibility for a healthy lifestyle” and “compensate to facilitate everyday life”. The second theme “using the app as a tool and means for communication” also comprised two subthemes; “dare to trust the app” and “feeling safe when sharing information with health care professionals”.Conclusions: The use of apps put increased responsibility on the person and had the possibility to make them more involved in their own care. The use of an app can facilitate a healthy lifestyle and help to monitor disease-specific symptoms. In order to be able to use apps for communication with the health care sector legislation and safety issues need to be considered. Implications for rehabilitation Apps can be used for self-management if they are safe and can be trusted. People with neurological disabilities want to be involved in their healthcare and needs to be addressed by health care professionals. The use of apps grasp over a wide variety of areas this is something that may be considered in health care and something that can be addressed by interdisciplinary approaches. Ordinary health-oriented apps and disease-specific apps were used differently and for different purposes.

Norge har for første gang kartlagt helsekompetansen i et stort og representativt utvalg av befolkningen. Resultater viser at en vesentlig andel i befolkningen har varierte utfordringer med å forholde seg til helseinformasjon. Dette har betydning for individets helse og samfunnets helseutgifter. Bakgrunn På oppdrag fra Helse- og omsorgsdepartementet har Helsedirektoratet i samarbeid med OsloMet og Høgskolen i Innlandet gjennomført en nasjonal kartlegging av befolkningens helsekompetanse. Kartleggingen inngår i et internasjonalt samarbeid initiert av det WHO-EHII tilknyttede nettverket Action Network on Measuring Population and Organisational Health Literacy (M-POHL) om gjennomføringen av Health Literacy Population Survey 2019–2021 (HLS19). Formålet med M-POHL og HLS19 er å skaffe til veie kunnskap som kan understøtte myndigheters differensierte arbeid med utvikling av målrettede tiltak for å styrke helsekompetansen i befolkningen, og for å tilpasse helsetjenesten slik at den ivaretar personer med ulik helsekompetanse. Gjennomføring I Norge valgte vi å bruke hele det omfattende spørreskjemaet International Health Literacy Population Survey Questionnaire (HLS19-Q47), som består av en base på 47 spørsmål. Undersøkelsen i Norge inkluderte også ulike skalaer for måling av digital helsekompetanse (herunder digital helseinformasjon, generelle digitale ferdigheter, og bruk av digitale helsetjenester), kompetanse i å navigere i helsevesenet, og ferdigheter i å kommunisere med helsepersonell. Undersøkelsen hentet videre inn helseøkonomiske variabler for å estimere størrelser som produktivitet og helsekostnader. Det ble samlet inn data fra to tilfeldige og representative utvalg på til sammen 6.000 respondenter. Spørreundersøkelsen ble gjennomført av et norsk gallupbyrå, som brukte metoden Computer-Assisted Telephone Interviewing (CATI). Deltakerlandene kunne velge mellom CAPI1, CATI og CAWI2/online. De fleste landene valgte CAPI. Befolkningens generelle helsekompetanse i lys av «pasientens helsetjeneste» Vi har rapportert enkel deskriptiv statistikk for alle de 47 spørsmålene i HLS19-Q47. Med bakgrunn i mer avanserte psykometriske analyser, har vi foreslått ulike delskalaer for hvert domene av helsekompetanse (helsefremming, sykdomsforebygging og helsetjenesterelatert). For å tilfredsstille strenge måletekniske ...

Background Huntington disease (HD) is an inherited genetic disorder that results in the death of brain cells. HD symptoms generally start with subtle changes in mood and mental abilities; they then degenerate progressively, ensuing a general lack of coordination and an unsteady gait, ultimately resulting in death. There is currently no cure for HD. Walking cued by an external, usually auditory, rhythm has been shown to steady gait and help with movement coordination in other neurological conditions. More recently, work with other neurological conditions has demonstrated that haptic (ie, tactile) rhythmic cues, as opposed to audio cues, offer similar improvements when walking. An added benefit is that less intrusive, more private cues are delivered by a wearable device that leaves the ears free for conversation, situation awareness, and safety. This paper presents a case study where rhythmic haptic cueing (RHC) was applied to one person with HD. The case study has two elements: the gait data we collected from our wearable devices and the comments we received from a group of highly trained expert physiotherapists and specialists in HD. Objective The objective of this case study was to investigate whether RHC can be applied to improve gait coordination and limb control in people living with HD. While not offering a cure, therapeutic outcomes may delay the onset or severity of symptoms, with the potential to improve and prolong quality of life. Methods The approach adopted for this study includes two elements, one quantitative and one qualitative. The first is a repeated-measures design with three conditions: before haptic rhythm (ie, baseline), with haptic rhythm, and after exposure to haptic rhythm. The second element is an in-depth interview with physiotherapists observing the session. Results In comparison to the baseline, the physiotherapists noted a number of improvements to the participant’s kinematics during her walk with the haptic cues. These improvements continued in the after-cue condition, indicating some lasting effects. The quantitative data obtained support the physiotherapists’ observations. Conclusions The findings from this small case study, with a single participant, suggest that a haptic metronomic rhythm may have immediate, potentially therapeutic benefits for the walking kinematics of people living with HD and warrants further investigation.

Spinal cord injury is a devastating condition that is followed by long and often unsuccessful recovery after trauma. The state of the art approach to manage paralysis and concomitant impairments is rehabilitation, which is the only strategy that has proven to be effective and beneficial for the patients over the last decades. How rehabilitation influences the remodeling of spinal axonal connections in patients is important to understand, in order to better target these changes and define the optimal timing and onset of training. While clinically the answers to these questions remain difficult to obtain, rodent models of rehabilitation like bicycling, treadmill training, swimming, enriched environments or wheel running that mimic clinical rehabilitation can be helpful to reveal the axonal changes underlying motor recovery. This review will focus on the different animal models of spinal cord injury rehabilitation and the underlying changes in neuronal networks that are improved by exercise and rehabilitation.

Background: Sudden onset neurological conditions, such as spinal cord injury and stroke, are unexpected, life-changing events. Research suggests that survivors grieve the life they knew, while commonly trying to cope with significant impairments impacting their everyday life. Some impairments are condition specific while others are shared across conditions, such as chronic pain. Aim: This research portfolio aimed to increase understanding of the experience of chronic pain following two sudden onset neurological conditions, namely spinal cord injury and stroke, in adults. Design: The portfolio consists of two main research papers, a systematic review which thematically synthesises qualitative findings on adults’ experience of chronic neuropathic pain following spinal cord injury and an interpretative phenomenological analysis (IPA) study which investigates the experience of working age adults living with chronic post-stroke pain. These are presented alongside an introduction, bridging section, extended methodology, and overall discussion. Findings: The systematic review identified six themes; ‘The pain as an unusual, intense, unpredictable and uncontrollable sensation’, ‘The pain’s influence on life’, ‘Trying to understand the pain’, ‘The challenge of describing the pain to others’, ‘The search for pain relief’ and ‘Learning pain acceptance over time’. The IPA study identified three master themes: ‘The solitude of the pain experience’, ‘Unsatisfactory healthcare and the need for self-care’ and ‘The development of pain acceptance’. Conclusions: The findings suggest that spinal cord injury and stroke patients have similar experiences of living with chronic pain. The pain is described as an invisible impairment, which is difficult to relate to others and can easily be overlooked in the context of other visible, more prototypical impairments. Primary healthcare settings are described as lacking specialist knowledge, leading to unsatisfactory identification, diagnosis and treatment. Recommendations for clinical applications and future research are provided.

Background: People with Parkinson’s disease (PD) often experience symptoms that affect their ability to eat as well as cardinal symptoms that increase energy expenditure (rigidity, tremor, bradykinesia). These symptoms may contribute to weight loss and increased risk of malnutrition. Objectives: The aim of this cross-sectional study was to investigate the prevalence of malnutrition risk, malnutrition and nutrition impact symptoms, like dysphagia among people with PD, who are patient members of the Norwegian Parkinson’s association. Methods: All registered patient members at the Norwegian Parkinson's Association were invited to respond to an online 24-item questionnaire via their registered email address. Background questions, as well as questions from two validated questionnaires were adapted to an online format (Nettskjema). The abridged patient-generated subjective global assessment (aPG-SGA) was used to measure nutritional status and The Radboud Oral Motor Inventory for Parkinson's disease (ROMP) was used to measure dysphagia. Results: The questionnaire was sent to 3047 registered members, of which 508 persons (17%) responded within the deadline (61% men). Of these, 59% were categorized as well-nourished (aPG-SGA A), 34% at risk of malnutrition (aPG-SGA B) and 6.5% as malnourished (aPG-SGA C). Malnourished participants had more swallowing problems than well-nourished, respectively, a mean total ROMP score of 15.5 (6.0) versus 9.0 (2.9). About half of all participants had difficulty swallowing solids, as well as concerns about these complaints. By adjusting for age and PD duration, the ROMP score was significantly associated with aPG-SGA score. A quarter of all participants reported symptoms that affected food intake, and the most frequently reported symptom being constipation (14.2%) and dry mouth (13.4%). On average, 3.4 (1.4) symptoms per malnourished participant were reported, as opposed to 0.1 (0.3) symptoms per well-nourished participant. Conclusion: Risk of malnutrition seems to be relatively common in people with PD. The prevalence was largely related to a number of self-reported symptoms, especially dysphagia. Symptoms affecting food intake should be systematically mapped in conjunction with PD to prevent malnutrition. Future research investigating the relationship between PD, malnutrition and dysphagia is needed.

Context: The existing literature indicates executive functioning (EF) deficits are related to a range of coping strategies, which in turn have been related to emotion regulation (ER) difficulties. However, less is known about the specific interactions between these constructs with attempts made to integrate theoretical models of EF or ER for neurological conditions. Aim: The broad aim of this portfolio is to explore ways specific EF domains interact with coping strategies in predicting ER difficulties. This will further inform existing clinical models of adjustment difficulties following Acquired Brain Injury (ABI) and Multiple Sclerosis (MS). Two papers are presented: a systematic review which explores relationships between EFs and mood outcomes via coping styles, and a quantitative study which explored interactional effects between aspects of dispositional mindfulness and EFs on ER difficulties. Results: Findings from the systematic review provide support for a range of adaptive coping strategies mediating and moderating relationships between specific EFs and mood outcomes for Multiple Sclerosis. The evidence for ABI is mixed and inconclusive, possible due to heterogeneity in brain injury samples whose patterns of cognitive issues could for some be protective but for others be problematic for ER. Findings from the empirical paper indicate some specific EF abilities related to cognitive flexibility may play a role in ER, and therefore may be of clinical relevance to clinical populations. Conclusions: The findings of this portfolio indicate potential positive implications for adaptive coping strategies when accounting for EF deficits, alongside findings of cognitive flexibility being associated with specific aspects of mindfulness and ER. However, further research is needed to verify and replicate those findings with better quality study designs and clinical populations where EF difficulties are apparent. Only by addressing these areas of future research can clinical recommendations regarding specific coping strategies be made for EF difficulties.

Master's thesis in Health informatics (HSI500) Background There is an increasing focus on the use of medical distance monitoring to improve the quality of patient care and increase the effectiveness of health care. Digital PRO-based solution is a new service for patients with epilepsy. The digital form the patient fills out is used as the basis for outpatient follow-up. Purpose The purpose of this study is to contribute knowledge to whether patients with epilepsy experience benefits of medical distance monitoring. The problem statement in the study was: "What experiences and thoughts do patients with epilepsy have about the utility of medical distance follow-up?" Selection and methodologyThe study has a qualitative method. Four semi-structured interviews were conducted of patients with epilepsy, who have used the PRO-based distance follow-up. Theoretical framework for mapping and analysis has been DeLone and McLean's (2003) Information System Success Model. Results/Conclusion The results show that there are different perceptions of PRO-based solution in medical distance follow-up. The informants in the study are largely satisfied with the treatment offered. Reduced travel time and less time spent in treatment impact the positive experiences the informants have with the digital scheduling solution. All informants in the study want to continue using the PRO-based solution, but they are uncertain of how this mode of treatment will affect their treatment over time. This is because they expect to be followed up regularly at the outpatient clinic, as distance follow-up is only a supplement to the treatment.

Objective.To determine the effect of aerobic exercise on brain-derived neurotrophic factor (BDNF) levels in people with neurological disorders.Data Sources.Six electronic databases (CINAHL, PubMed, Cochrane, PsycINFO, SportDiscus, and Web of Science) were searched until the end of December 2016.Study Selection.Experimental or observational studies of people with neurological disorders who undertook an exercise intervention with BDNF as an outcome measure. The search strategy yielded 984 articles.Data Extraction.Study data were independently extracted from each article. Methodological quality of studies was assessed using the Physiotherapy Evidence Database (PEDro) scale. A meta-analysis was planned based on the assessment of predetermined criteria.Data Synthesis.Eleven articles were included. Studies employed either a program of aerobic exercise, a single bout of aerobic exercise, or both. A meta-analysis of studies comparing a program of aerobic exercise against usual care/nil therapy showed a large effect (SMD: 0.84, 95% CI 0.47–1.20,p<0.001) in favour of aerobic exercise to increase levels of BDNF. Findings for a single bout of aerobic exercise were mixed. Quality of studies was low (PEDro average score 4.3/10).Conclusions.A program of aerobic exercise may contribute to increased levels of BDNF in neurological populations.

Background. Problems with gait in Parkinson’s disease (PD) are a challenge in neurorehabilitation, partly because the mechanisms causing the walking disability are unclear. Weakness and fatigue, which may significantly influence gait, are commonly reported by patients with PD. Hence, the aim of this study was to investigate the association between weakness and fatigue and walking ability in patients with PD.Methods. We recruited 25 patients with idiopathic PD and 25 age-matched healthy adults. The maximum voluntary contraction (MVC), twitch force, and voluntary activation levels were measured before and after a knee fatigue exercise. General fatigue, central fatigue, and peripheral fatigue were quantified by exercise-induced changes in MVC, twitch force, and activation level. In addition, subjective fatigue was measured using the Multidimensional Fatigue Inventory (MFI) and Fatigue Severity Scale (FSS).Results. The patients with PD had lower activation levels, more central fatigue, and more subjective fatigue than the healthy controls. There were no significant differences in twitch force or peripheral fatigue index between the two groups. The reduction in walking speed was related to the loss of peripheral strength and PD itself.Conclusion. Fatigue and weakness of central origin were related to PD, while peripheral strength was important for walking ability. The results suggest that rehabilitation programs for PD should focus on improving both central and peripheral components of force.

Background The importance of rehabilitation therapy in Parkinson's disease is well recognized. However, the effects of an inpatient rehabilitation program for advanced Parkinson's disease have not been fully investigated. Aim To assess the effects of intensive inpatient rehabilitation. Methods We enrolled 31 patients (mean age 69.5 ± 9.4 years; mean disease duration 8.8 ± 6.4 years) with advanced Parkinson's disease, without severe cognitive impairment. The median Hoehn–Yahr stage was IV. Patients received 2 h of individualized rehabilitation for 6–7 days each week for 1 month. At hospital discharge, patients and caregivers were instructed to continue daily exercise. Results Motor and total scores of Functional Independence Measures significantly improved between admission and discharge in patients with stage III and IV disease, but not stage V. There was no significant effect of Hoehn–Yahr stage on improvements in Unified Parkinson's Disease Rating Scale scores, (total, part I, II or III), cognitive Functional Independence Measures or Berg Balance Scale. Conclusion Intensive inpatient rehabilitation was effective even in advanced Parkinson's disease. Intensive inpatient rehabilitation, together with home and day-care exercise, might counteract the progressive motor decline in Parkinson's disease.

Background Gait disorders in individuals with Parkinson’s disease (PD) may be associated with alterations in the motor control system and aggravated by psychoemotional and cognitive issues. Therapeutic strategies aimed at self-perception and motor regulation seem to be promising. Motor imagery (MI) has been shown to be one of these strategies, but there is still no clear evidence of its applicability in this population. The aim of this trial is to determine the effects of motor-imagery training on the gait and electroencephalographic activity of individuals with PD. Methods/design The sample will consist of 40 individuals, aged between 45 and 75 years, in the mild and moderate phase of the disease, with the ability to generate voluntary mental images. They will be assessed for cognitive level, degree of physical disability, mental-image clarity, kinematic gait variables, electroencephalographic activity and mobility. Next, subjects will be randomly assigned to an experimental group (EG) and a control group (CG). The EG will perform motor imagery and gait, while the CG will only engage in gait exercises. Twelve training sessions will be conducted lasting up to 90 min each, three times a week, for 4 weeks. The subjects will be reassessed on the kinematic variables of gait, electroencephalographic activity and mobility at 1, 7 and 30 days after the final training session. Discussion The results may provide an important advance in neurological rehabilitation where an easy-access and low-cost intervention may help to improve gait, electroencephalographic activity and mobility in individuals with PD.

During robot-aided motion rehabilitation training, inappropriate difficulty of the training task usually leads the subject becoming bored or frustrated; therefore, the difficulty of the training task has an important influence on the effectiveness of training. In this study, an adaptive task level strategy is proposed to intelligently serve the subject with a task of suitable difficulty. To make the training task attractive and continuously stimulate the patient's training enthusiasm, diverse training tasks based on grabbing game with visual feedback are developed. Meanwhile, to further enhance training awareness and inculcate a sense of urgency, a dynamic score feedback method is used in the design of the training tasks. Two types of experiments, functional and clinical rehabilitation experiments, were performed with a healthy adult and two recruited stroke patients, respectively. The experimental results suggest that the proposed adaptive task level strategy and dynamic score feedback method are effective strategies with respect to incentive function and rehabilitation efficacy.

Denne studien viser hvordan kunnskapsbasert fysisk gruppetrening og stemmetrening i grupper kan tilpasses og gjennomføres for hjemmeboende personer med Parkinsons sykdom i en kommune. Metode: Medvirkningsbasert aksjonsforsknings- og kvalitetsutviklingsdesign. Gjennomført i samarbeid med to private fysioterapeuter og en privat logoped, Asker kommune og forskere fra Universitetet i Sørøst-Norge, representanter fra Unicare og Norges Parkinsonforbund, samt faglige ressurspersoner. Organisert i faser som bygger på hverandre med lokal forankring og nettverksbygging, kunnskapstilegning, hospitering og opplæring av terapeutene, individuell kartlegging og opplæring av personer med Parkinsons sykdom, tilpassing og gjennomføring av stemme- og fysisk gruppetrening, individuell retesting og evalueringer. Data: PDQ-39, MNA, VHI, ROMP, Voice Analyst, TUG, 5xReise/sette seg, Step Test, 8M gangtest, 6 Min Gåtest, Borg skala. Individuelle kvalitative intervjuer ved inklusjon, etter 6 og 12 mnd trening, samt fokusgruppeintervjuer. Multivariate forskningsanalyser. Resultater. 31 personer med Parkinsons sykdom gjennomførte 60 minutter fysisk treningsprogram inspirert av Parkinson Wellness Recovery, PWR to ganger pr uke i 12 mnd. PDQ-39 viste ingen signifikante endringer. Fysiske tester med StepTest, Reise/sette seg test, 8M gangtest, 6Min gåtest viste signifikante forskjeller med bedring i funksjon fra oppstart og etter 12 måneders fysisk gruppetrening. Deltagerne rapporterte at treningsprogrammet bidro til økt styrke, balanse og hurtighet. Standardisert testing hver 6 mnd og trening i gruppe styrket treningsmotivasjonen. 14 personer med Parkinsons sykdom gjennomførte 60 minutter stemmetreningsprogram inspirert av Pitch Limiting Voice Treatment, PLVT tre ganger pr. måned i 12 mnd. Radbound Oral Motor Inventory for Parkinsons disease (ROMP) og Voice Handicap Index (VHI) viste ingen signifikante endringer. Stemmetest med Voice Analyst Test viste signifikant forskjeller med bedring i stemmekvaliteten, pitch, fra oppstart til etter 12 måneder stemmetrening. Deltagerne rapporterte at de lærte å korrigere stemmen og bruke den dype stemmen ved bevisstgjøring, terping på øvelser samt ny kunnskap. Standardisert testing hver 6 mnd, stemmetreningsøvelser og samtaler i grupper var motiverende. Konklusjon og anbefalinger: Personer med Parkinsons sykdom har ulik fysisk funksjon og ulik grad av endringer i stemmen. Gruppetrening må organiseres kontinuerlig, tilpasses den enkelte og ledes av fysioterapeuter og logoped med spesiell opplæring. Treningen er diagnosespesifikk og antiparkinsonistisk. Personer med Parkinsons sykdom trenger tid og repetisjoner for å lære øvelsene, gjøre de riktig og gjennomføre 60 minutters gruppetreningsprogram. Informasjon om effekten av stemme – og fysisk gruppetrening for personer med Parkinsons sykdom bør spres til alt helsepersonell; ‘Trening nytter’.

Objective The goal of this contribution is to gather and to critically analyze recent evidence regarding the potential of exergaming for Parkinson’s disease (PD) rehabilitation and to provide an up-to-date analysis of the current state of studies on exergame-based therapy in PD patients. Methods We performed our search based on the conclusions of a previous systematic review published in 2014. Inclusion criteria were articles published in the indexed databases Pubmed, Scopus, Sciencedirect, IEEE and Cochrane published since January 1, 2014. Exclusion criteria were papers with a target group other than PD patients exclusively, or contributions not based on exergames. Sixty-four publications out of 525 matches were selected. Results The analysis of the 64 selected publications confirmed the putative improvement in motor skills suggested by the results of the previous review. The reliability and safety of both Microsoft Kinect and Wii Balance Board in the proposed scenarios was further confirmed by several recent studies. Clinical trials present better (n = 5) or similar (n = 3) results than control groups (traditional rehabilitation or regular exercise) in motor (TUG, BBS) and cognitive (attention, alertness, working memory, executive function), thus emphasizing the potential of exergames in PD. Pilot studies (n = 11) stated the safety and feasibility of both Microsoft Kinect and Wii Balance Board, potentially in home scenarios as well. Technical papers (n = 30) stated the reliability of balance and gait data captured by both devices. Related meta-analyses and systematic reviews (n = 15) further support these statements, generally citing the need for adaptation to patient’s skills and new input devices and sensors as identified gaps. Conclusion Recent evidence indicates exergame-based therapy has been widely proven to be feasible, safe, and at least as effective as traditional PD rehabilitation. Further insight into new sensors, best practices and different cognitive stadiums of PD (such as PD with Mild Cognitive Impairment), as well as task specificity, are required. Also, studies linking game parameters and results with traditional assessment methods, such as UPDRS scores, are required. Outcomes for randomized controlled trials (RCTs) should be standardized, and follow-up studies are required, particularly for motor outcomes. Electronic supplementary material The online version of this article (10.1186/s12984-019-0492-1) contains supplementary material, which is available to authorized users.

Background: The recent exponential growth of Digital Health (DH) in the healthcare system provides a crucial transformation in healthcare, answering to alarming threats related to the increasing number of Chronic Neurological Diseases (CNDs). New long-term integrated DH-care approaches, including rehabilitation, are warranted to address these concerns. Methods: The Human Empowerment Aging and Disability (HEAD) rehabilitation program, a new long-term integrated care including DH-care system, was evaluated in terms of efficiency and patient-reported outcome measures (PROMs) in 107 CND patients (30 with Parkinson's Disease, PD; 32 with Multiple Sclerosis, MS; 45 with stroke in chronic stage). All participants followed 1-month of HEAD rehabilitation in clinic (ClinicHEAD: 12 sessions, 3/week), then 1:3 patient was consecutively allocated to 3-months telerehabilitation at home (HomeHEAD: 60 sessions, 5/week). Efficiency (i.e., adherence, usability, and acceptability) and PROMs (i.e., perceived functioning in real-world) were analyzed. Results: The rate of adherence to HEAD treatment in clinic (≥90%) and at home (77%) was high. Usability of HEAD system was judged as good (System Usability Scale, median 70.00) in clinic and even more at home (median 80.00). Similarly, administering the Technology Acceptance Model 3 questionnaire we found high scores both in clinic/at home (Usefulness, mean 5.39 ± 1.41 SD/mean 5.33 ± 1.29 SD; Ease of use, mean 5.55 ± 1.05 SD/ mean 5.45 ± 1.17 SD, External Control, mean 4.94 ± 1.17 SD/mean 5.07 ± 1.01 SD, Relevance, mean 5.68 ± 1.29 SD/mean 5.70 ± 1.13 SD and Enjoyment, mean 5.70 ± 1.40 SD/mean 6.01 ± 1.08 SD). After ClinicHEAD, participation and autonomy in daily routine was maintained or even ameliorated (PD and stroke > MS). Whereas, increased functionality and participation in the MS group was found only after HomeHEAD intervention. Discussion: Our results suggest that a tele-health-based approach is both feasible and efficient in providing rehabilitation care to CNDs from clinic to home. Increasing and maintaining participation as well as autonomy in daily routine are promising findings that open up scenarios for the continuity of care at home through DH-care for CNDs.

In the original article [1], we mentioned that some study characteristics of the article by Dagan and colleagues [2] were unavailable. However, we realized that the authors provided the relevant information in their supplementary file. As such, we added participant characteristics (i.e., age = 68.8 ± 6.8, gender = 17 M, 3 F, PD duration = 9.0 ± 5.7, and UPDRS Part III at baseline = Total 39.7 ± 14.6) to Table 1, stimulation parameters (i.e., intensity = 3 mA, duration = 20 min, areas = 3 cm2) to Table 2, and methodological quality assessments (i.e., allocation concealment = 1 and Total score = 9) to Table 3. Based on the new information, we updated Fig. 2 with the corrected selection bias and performance bias results. Finally, we confirmed that these corrections did not change the meta-analytic findings in the original article.

Parkinson disease is very common in the world, ranking second to Alzheimers disease in terms of degenerative neurological disorders. The disease since 1817 has had so many researchers looking into it, bringing out symptoms, possible treatment options, causes of the disorder to mention but a few. There are a number of studies that have looked into the symptoms of the disorder, especially the non-motor symptoms of the disorder. This study looks into the motor symptoms associated with the disease. It brought out the causes, which the study from the literature review conducted asserted that there is no known cause for it, however, about 60 to 80 percent of persons with PD, have a degenerating number of dopamine, as such, this can be postulated to be the cause. The study also affirmed that there is no known treatment for the symptoms, doctors and medical practitioners would therefore have to try different forms of treatment till the right one for the patient is arrived at.

MS-DOS er et forprosjekt som undersøker muligheter for at personer med multippel sklerose (MS) og relevante helseaktører kan ta i bruk digitale hjelpemidler for bedre oppfølging, behandling og mestring av sykdommen. Målet for MS-DOS er å samle informasjon om hvilke utfordringer personer med MS opplever på grunn av sin sykdom, og vurdere i hvilken grad digitale verktøy kan gjøre livet bedre for denne gruppen. Denne rapporten gir et overblikk over helsetilbudet til personer med MS. Deretter presenteres resultater fra en dybdestudie hvor vi følger tre personer med MS over en periode på seks uker. Metoden vi har brukt er observasjon og intervjuer, samt kartlegging av planlagte og reelle pasientforløp ved hjelp av Customer Journey Modelling Language. Rapporten presenterer til slutt muligheter for bruk av digitale støtteverktøy, og forslag til videre studier Oppdragsgiver: Helsedirektoratet ved Innomed

Questions For people with idiopathic Parkinson's disease, does a 6-week, comprehensive, home exercise program reduce falls and disability and improve health-related quality of life? Is the program cost-effective? Design Randomised, controlled trial with concealed allocation and assessor blinding. Participants One hundred and thirty-three community-dwelling adults with Parkinson's disease. Intervention The experimental group completed a 6-week home program comprising progressive resistance strength training, movement strategy training and falls education. The control group completed 6 weeks of non-specific life skills training. Participants in both groups received weekly therapist-guided sessions for 6 consecutive weeks and a weekly self-directed home program. Outcome measures The primary outcome was the rate of falls, documented for the 12-month period immediately after therapy. Secondary outcomes were disability and health-related quality of life, assessed before and after intervention and at a 12-month follow-up. Results A total of 2255 falls were reported by the 12-month follow-up. The proportion of fallers in the experimental and control groups was 61 and 72%, respectively, which was not statistically significantly different (RR=0.85, 95% CI 0.66 to 1.09). There was no significant between-group difference in the rate of falls (incidence rate ratio=1.58, 95% CI 0.73 to 3.43). A survival analysis of participant time to first fall did not show a significant between-group difference (log-rank test χ 2 =0.79, p =0.37). No significant between-group differences occurred for mobility, disability or quality of life. The mean cost of delivering the experimental intervention was AUD1596. Conclusion A home program of strength and movement strategy training and falls education does not prevent falls when applied at the dose used in this study. Arguably, the dosage of therapy was insufficient. Future trials need to explore further therapy content, repetitions and duration, in order to optimise outcomes and cost-effectiveness. [Morris ME, Taylor NF, Watts JJ, Evans A, Horne M, Kempster P, Danoudis M, McGinley J, Martin C, Menz HB (2017) A home program of strength training, movement strategy training and education did not prevent falls in people with Parkinson's disease: a randomised trial. Journal of Physiotherapy 63: 94–100]

Contains fulltext : 177879.pdf (Publisher’s version ) (Open Access) Current medical management is only partially effective in controlling the symptoms of Parkinson's disease. As part of comprehensive multidisciplinary care, physical therapy and occupational therapy aim to support people with Parkinson's disease in dealing with the consequences of their disease in daily activities. In this narrative review, we address the limitations that people with Parkinson's disease may encounter despite optimal medical management, and we clarify both the unique and shared approaches that physical therapists and occupational therapists can apply in treating these limitations.

Pårørende utfører viktige omsorgsoppgaver og er en verdifull ressurs i omsorgsfelleskapet. Mange pårørende har store og tyngende omsorgsoppgaver. Det er derfor viktig at pårørende verdsettes for innsatsen de gjør, mottar veiledning og støtte når det er behov for det. Et godt samspill mellom pårørende og tjenesteyter, hvor de kjenner hverandres roller, behov og innsats, vil bidra til forutsigbarhet og trygghet i omsorgssituasjonen.

Background: Inflammatory cytokine levels are often elevated in people with Parkinson’s disease (PD). People with PD often experience sleep disturbances that significantly impact quality of life. Past studies suggest inflammatory cytokines may be associated with various symptoms of PD. Benefits of Qigong, a mind–body exercise, have been shown in different neurological conditions, but there is still a lack of clinical evidence in the PD population. Methods: Ten people with PD were recruited and randomly assigned into two groups receiving six weeks of Qigong (experimental group) or sham Qigong (control group) intervention. The levels of TNF-α, IL-1β, and IL-6 in subjects’ serum and sleep quality were measured before and after the intervention. Results: After the intervention, the serum level of TNF-α in the experimental group was significantly decreased in all subjects, while the level in the control group showed a trend to increase. Qigong exercise significantly improved sleep quality at night. There was a strong correlation between changes in the level of TNF-α and sleep quality. Conclusion: Qigong exercise decreased TNF-α level in people with PD and helped improve sleep quality. TNF-α may have a potential to influence the sleep quality in people with PD.

Hensikten med undersøkelsen har vært å kartlegge tjenester rettet mot voksne personer med nevrologisk lidelse. Formålet er beskrevet slik: «Det er behov for å kartlegge effekter av ulike modeller for samhandling mellom tjenestenivåene, som skaper forutsigbarhet og koordinerte tjenester for personer med nevrologiske lidelser». Informasjonen rapporten bygger på er fremkommet gjennom intervju med ledere i 44 kommuner. Kommunene inngår i et «omsorgsforskningspanel», et representativt utvalg av kommuner som omsorgsforsknings-sentrene har valgt ut tilfeldig. Å synliggjøre samhandlingsmodeller mellom ulike tjenestenivå om lovpålagte tjenester er sentralt. Tema i intervjuene var: koordinering av tjenester, identifisering av ulike samhandlingspartnere og -modeller, brukermedvirkning, bruk av Individuell Plan (IP), habilitering og rehabilitering og supplerende tjenester. Det er kun hovedfunnene som gjengis i rapporten. Semi-strukturert intervju med intervjuguide ble benyttet. Hovedtendenser: Informantene understreker at tjenestemottaker skal være omdreiningspunkt for aktuelle tjenester. Lovpålagte tjenester, som Koordinerende enhet (KE), IP og rehabilitering blir prioritert av tjenesteyterne. Tilbudene for å innfri tjenestene varierer avhengig av region og kommunestørrelse. Det fremkommer at fastlegen innehar en nøkkelrolle i samspill med tjenestemottaker, KE, spesialisthelsetjenesten, kommunehelsetjenesten og andre tjenesteytere. Små kommuner viser stor oppfinnsomhet med hensyn til å imøtekomme ønsker og behov for brukeren til tross for lite fagmiljø. Mangel på fagfolk vanskeliggjør etablering av systemer og rutiner. Store kommuner har utarbeidet gode retningslinjer for deler av tjenestetilbudet. Det viser seg at tjenestemottaker og pårørende i økende grad er ressurssterke og krever mer fra tjenesteapparatet. Det kan oppleves som en spennende utfordring for tjenesteyterne. Når det offentlige tjenesteapparat fungerer viser tjenesteyterne kreativitet og engasjement for å kunne skreddersy individuelle løsninger for tjenestemottaker. Det ligger store utfordringer i å utvikle samhandlingsmodeller som ivaretar lovpålagte ytelser og samtidig ivaretar leksibilitet i utforming og utøving av tjenestene.

Hensikten med undersøkelsen har vært å kartlegge tjenester rettet mot voksne personer med nevrologisk lidelse. Formålet er beskrevet slik: «Det er behov for å kartlegge effekter av ulike modeller for samhandling mellom tjenestenivåene, som skaper forutsigbarhet og koordinerte tjenester for personer med nevrologiske lidelser». Informasjonen rapporten bygger på er fremkommet gjennom intervju med ledere i 44 kommuner. Kommunene inngår i et «omsorgsforskningspanel», et representativt utvalg av kommuner som omsorgsforsknings-sentrene har valgt ut tilfeldig. Å synliggjøre samhandlingsmodeller mellom ulike tjenestenivå om lovpålagte tjenester er sentralt. Tema i intervjuene var: koordinering av tjenester, identifisering av ulike samhandlingspartnere og -modeller, brukermedvirkning, bruk av Individuell Plan (IP), habilitering og rehabilitering og supplerende tjenester. Det er kun hovedfunnene som gjengis i rapporten. Semi-strukturert intervju med intervjuguide ble benyttet. Hovedtendenser: Informantene understreker at tjenestemottaker skal være omdreiningspunkt for aktuelle tjenester. Lovpålagte tjenester, som Koordinerende enhet (KE), IP og rehabilitering blir prioritert av tjenesteyterne. Tilbudene for å innfri tjenestene varierer avhengig av region og kommunestørrelse. Det fremkommer at fastlegen innehar en nøkkelrolle i samspill med tjenestemottaker, KE, spesialisthelsetjenesten, kommunehelsetjenesten og andre tjenesteytere. Små kommuner viser stor oppfinnsomhet med hensyn til å imøtekomme ønsker og behov for brukeren til tross for lite fagmiljø. Mangel på fagfolk vanskeliggjør etablering av systemer og rutiner. Store kommuner har utarbeidet gode retningslinjer for deler av tjenestetilbudet. Det viser seg at tjenestemottaker og pårørende i økende grad er ressurssterke og krever mer fra tjenesteapparatet. Det kan oppleves som en spennende utfordring for tjenesteyterne. Når det offentlige tjenesteapparat fungerer viser tjenesteyterne kreativitet og engasjement for å kunne skreddersy individuelle løsninger for tjenestemottaker. Det ligger store utfordringer i å utvikle samhandlingsmodeller som ivaretar lovpålagte ytelser og samtidig ivaretar fleksibilitet i utforming og utøving av tjenestene.