6 Abstract The rehabilitation of patients with brain damage is an interprofessional, complex, intensive, long-lasting and individually oriented process. One frequent consequence of brain damage is hemiparesis, which also causes a disorder of the upper extremity movement pattern. The movement ability of the upper extremity is essential for an individual's self-sufficiency, the performance of common daily activities, and thus for an independent life in a family setting. Special therapeutic rehabilitation approaches should involve the training of new activities, including the motor learning mechanism that activates brain plasticity. A functional reorganization of the motor cortex occurs along with the activation of reserve neurons and the replacement of damaged synapses. One of the aims of this work was to demonstrate, using objective function methods, the possibility of influencing the movement patterns of a paretic upper extremity by means of intensive interprofessional rehabilitation even several years after the brain damage. The second aim was to demonstrate that the monitoring of motor functions in patients after brain damage leads to improved motivation, thereby improving motor functions. A study was conducted among 55 selected patients after brain damage with central hemiparesis who participated in the...

Rehabilitation of patients after brain damage is an multidisciplinary, complex, intensive, long- term and individual process. Standardized functional instruments for the assessment of the degree of disability and functional abilities of patients are not usually used in rehabilitation in the Czech Republic. Often, motor disorder post brain damage results in hemiparesis and causes impairment of upper arm movement pattern. Movement ability of the upper arm is vital for self-sufficiency, activities of daily life and maintaining an independent family life. Special rehabilitation therapeutic techniques must involve the training of new activities including the mechanism of motor learning which is responsible for functional reorganization of the motor cortex regions, and the activation of reserve neurons for reparation. The aim of the study is to demonstrate that an accelerometer is a suitable instrumet for objective monitoring of impairment of the upper arm movement pattern. Another aim of the study is to demostrate if the FIM test (Functional Independence Measures) and Jebsen-Taylor (JT) test are appropriate instruments for detecting changes of the upper arm movement pattern after intensive, individual and multidisciplinary rehabilitation brain damage patients. Clinical study was undertaken with selected...

1 Abstract The purpose of this study was to describe the degree of bilateral asymmetry of lower limbs' muscle activity in the dance movement Cha-cha-cha and to determine the cause of bilateral asymmetries of lower limbs' muscle activity. Differences in muscle activity of contralateral lower limbs might be caused by the factor of bilaterally asymmetrical movement patterns, the factor of neural pathways or the factor of training. We hypotetize that comparing the direction of bilateral asymmetry in muscle activity between asymmetrical dance movement and its mirror alternative can determine the cause of bilateral asymmetry in muscle activity of lower limbs within the movement. We studied 14 volunteers (7 men, 7 women), all were actively dancing at competitive level. We tested the muscle activity of musculus vastus lateralis (VL), musculus biceps femoris (BF), musculus tibialis anterior (TA) a musculus gastrocnemius lateralis (GL) using surface electromyography. The dance movement Cha-cha-cha was bilaterally asymmetrical in the muscle activity of VL, TA and GL. Direction of lower limbs' muscle activity indicates, that TA, being a muscle responsible for foot movement, might be affected by the factor of neural pathways and brain laterality, while VL and GL might be more affected by the factor of training. Key...

Background: Cheap and effective tools for measuring patients’ physical activity (PA) level are needed. The first aim in this thesis was therefore to assess the validity of two PA -questions, and their three associated answer modes, that are used within the Swedish health care system. Sitting, light intensity PA (LIPA), and moderate and vigorous intensity PA (MVPA), are associated with health and longevity, but detailed population data assessed with objective methods is needed. The second aim was thus to assess the above with motion sensor technology, in a middle-aged Swedish sample. Low self-perceived health is a strong predictor of morbidity and mortality, but this association may vary over time with changes in the society and our lifestyle. The third aim was to assess secular trends in the interrelations between self-perceived health, physical fitness, and selected covariates. The effects of PA on prescription (PAP) on health-related quality of life (HRQoL) in overweight adults are unclear, thus the fourth aim was to explore this. Methods: All data was collected in the Swedish population. Data from the PA -questions and accelerometers, aerobic fitness, counter movement jump, and balance tests, blood samples, and self-rated general health were collected in 365 participants, 21–66 yrs. The PA pattern was assessed in 948 individuals, 50‒64 yrs, from the SCAPIS pilot study. Self-perceived physical health, and measured aerobic fitness, counter movement jump height, and balance, and demographic and lifestyle data, was assessed in three independent samples from 1990, 2000 and 2013, including 3564 adults, 20‒65 yrs. The effects of Swedish PAP on HRQoL was assessed in a randomized controlled trial including 101 men and women, 67‒68 yrs, that were inactive, overweight (BMI>25 kg/m2), and had a waist circumference ≥102 cm (men) or ≥88 cm (women), who were randomized to an intervention group or a control group. The 36-item Short Form Health Survey (SF-36) was used to assess HRQoL. Results: The multiple choice answer mode of the two PA -questions was found to have the strongest validity, compared with the two other (an open mode, and one where PA minutes is specified per weekday). The validity is in line with many other established PA-questionnaires, but the open mode has limitations. The assessment of PA pattern showed that 61% of motion sensor wear time represented sitting, 35% LIPA, and 4% MVPA. Only 7% of the sample met the PA recommendations. The odds for describing perceived health as good was found to increase by 5% per each increment of 1 ml/kg/min in VO2max. This was stable across genders and all three LIV-samples (i.e. over time). Waist circumference, chronic disease, sleep problems, and level of satisfaction with one’s life, were also important correlates. The Swedish PAP group improved significantly more, and more participants displayed clinically relevant improvements (OR 2.43), in mental aspects of HRQoL, compared to the controls. Physical aspects of HRQoL improved in the PAP group, but not in the control group. Conclusions: The multiple choice answer mode has the strongest validity and Open mode the weakest. The PA -questions may be used in populations, or in individuals to determine appropriateness for treatment. The questions’ advantages and limitations must be considered and further reliability and validity studies are needed. The results regarding sitting, LIPA, MVPA and fulfillment of PA recommendations, are of high clinical relevance. A great challenge remains to further implement methods to increase the level of PA in the Swedish population. Physical fitness is related to self-perceived health independently of changes in society and lifestyle over time, and simple questions may be useful for the clinical assessment of physical fitness. Swedish PAP has a positive effect on mental aspects of HRQoL, measured by the SF-36. This finding supports the clinical use of the Swedish PAP model. / LIV 2013

Abstract The preverbal vocalisation up to the first word, feeding skills as well as motor development until the first steps of ELBW preterm infants without disability were compared in this descriptive study to those of healthy full-term infants. In addition, preverbal and feeding skills were studied in relation to gross motor movement patterns. The preverbal development of preterm infants proceeded according to the same temporal schedule as that of full-term infants, however, preterm infants failed to produce several vocalisation skills that full-term infants presented. The preterm infants increased their vocalisation slower than the full-term infants in the beginning of each of the developmental stages. The difference between the preterm and the full-term infants grew when approaching syllables, syllable combinations, and words. The preterm infants reached the first word approximately two months later than the full-term infants. The suckling of preterm infants was either disorganised or dysfunctional, while normal or disorganised in the case of full-term infants. The preterm infants reached the spoon-feeding skills approximately at the same (corrected) ages as the full-term infants, but the transitions to new stages were difficult. Half of the preterm infants suffered from feeding problems while only two of the full-term infants had feeding problems. Both the preterm and full-term infants reached vocalisation and feeding skills in relation to gross motor movement patterns earlier than assumed according to the predominant clinical knowledge. The vocalisation and feeding skills did not seem to be dependent upon the gross motor development. / Tiivistelmä Tässä kuvailevassa tutkimuksessa tarkasteltiin tiiviissä seurannassa erittäin ennenaikaisina ja pienipainoisina syntyneiden lasten esileksikaalista ääntelyä ensisanaan asti sekä syömistaitojen ja motoriikan kehitystä ensiaskeliin asti. Tuloksia verrattiin terveiden, täysiaikaisina syntyneiden lasten vastaaviin taitoihin. Lisäksi ääntelyn ja syömisen kehitystä tarkasteltiin suhteessa karkeamotoristen taitojen kehitysaikatauluun. Ennenaikaisesti syntyneiden lasten ääntely kehittyi saman aikataulun mukaan kuin täysiaikaisten lasten ääntely. Ennenaikaisesti syntyneet lapset jättivät kuitenkin väliin taitoja, jotka täysiaikaisina syntyneet lapset saavuttivat. Siirryttäessä uusille ääntelyn ja kielen kehitystasoille ennenaikaisina syntyneiden lasten ääntelyn määrä lisääntyi hitaammin kuin täysiaikaisina syntyneiden lasten ääntelyn määrä. Ero ennenaikaisina ja täysiaikaisina syntyneiden lasten kehityksessä kasvoi lähestyttäessä tavuja, tavuyhdistelmiä ja sanoja. Ennenaikaisesti syntyneet lapset saavuttivat ensisanavaiheen kaksi kuukautta täysiaikaisia lapsia myöhemmin. Ennenaikaisina syntyneiden lasten syömisen taidoissa havaittiin, että varhainen imeminen oli joko jäsentymätöntä tai poikkeavaa, kun täysiaikaisina syntyneillä se oli puolestaan normaalia tai jäsentymätöntä. Ennenaikaisina syntyneet lapset oppivat käsittelemään soseita ja kiinteitä ruokia samassa (korjatussa) iässä kuin täysiaikaisina syntyneet lapset, mutta siirtyminen kehitysvaiheesta toiseen tuotti vaikeutta. Puolet ennenaikaisista lapsista kärsi syömisvaikeuksista. Sen sijaan täysiaikaisina syntyneistä lapsista kahdella todettiin syömisen vaikeutta. Sekä ennenaikaisina että täysiaikaisina syntyneet lapset oppivat ääntelyn ja syömisen taitoja ennen tiettyjä karkeamotorisia liikemalleja, joiden on vallitsevan kuntoutuskäsityksen mukaisesti oletettu edeltävän näiden taitojen saavuttamista. Ääntelyn ja syömisen taidot eivät siis näyttäneet olevan riippuvaisia karkeamotoriikan kehityksestä.