Trapezius myalgia is a pain condition that usually develops in people with repetitive and stressful work tasks, which can lead to chronic widespread pain (CWP). This work compares protein expression levels in healthy women with those in women who have chronic widespread pain, including pain in the trapezius muscle, by using a proteomic approach.  Twodimensional gel electrophoresis and silver staining with a subsequent digital quantification of protein spots was used to detect spots which had significantly higher protein levels in either group. Preparative gels were made and stained with SYPRO Ruby, the protein spots that were significantly different between the groups were picked from the SYPRO Ruby gels and identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, MALDI-TOF. The optical density of seven protein spots were significantly decreased in the trapezius muscle of the CWP subjects; however the standard deviations were notably high. Five of the seven proteins could be identified as desmin, creatine kinase B-type, serum albumin, heat shock protein beta-1 and slow skeletal muscle troponin T. Apart from serum albumin, all these proteins can possibly be responsible for pain in the trapezius muscle in CWP. In conclusion, this study demonstrates that two-dimensional gel electrophoresis in combination with mass spectrometry is a powerful tool to identify potential biomarkers of musculoskeletal pain in subjects with CWP. The results may provide new insights into the mechanisms and patho-physiology of trapezius myalgia.

The rupture of an aneurysm in subarachnoid hemorrhage (SAH) is a dramatic event causing a severe impact on the brain and a transient or permanent ischemic condition. Several types of responses to meet the challenges of SAH have been found in the acute phase, including activation of the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic nervous system, elevated levels of brain natriuretic peptide (BNP), and disturbances in cerebral and systemic metabolism. Cerebral metabolism and the endocrine stress response in the ultra-early phase was investigated in a novel porcine model of SAH in which autologous blood was injected to the anterior skull base. Early activation of the HPA axis was found with rapid elevation of adrenocorticotrophic hormone, cortisol and aldosterone. The peak values of these hormones were early and may be impossible to catch in patients. There were indications of a sympathetic nervous response with excretion of catecholamines in urine as well as plasma chromogranin-A elevation. Cerebral microdialysis suggested immediate substrate failure followed by hypermetabolism of glucose. The animal model seems suited for further studies of aneurysmal SAH. NT-proBNP was investigated in 156 patients with SAH, there was a dynamic course with increasing levels during the first 4 days of the disease. Factors predicting high NT-proBNP load included female sex, high age, high Troponin-I at admission, angiographic finding of an aneurysm and worse clinical condition at admission. High levels of NT-proBNP were correlated to factors indicating a more severe disease, suggesting the initial injury in aneurysmal SAH is an important factor in predicting high NT-proBNP during the acute stage of the disease. Measurements with indirect calorimetry were performed daily during the first week after SAH on 32 patients with SAH. There was a dynamic course with increasing energy expenditure (EE) the first week after SAH. Comparisons with three predictive equations indicated that measured EE generally is higher than predicted, but considerable variation exists within and between patients, indicating that prediction of EE in SAH is difficult. Altogether, the studies demonstrate a complicated response in acute SAH that needs to be further studied to increase possibility of good outcome in SAH patients.

Background: Approximately a third of all stroke patients develop spatial neglect, a debilitating symptom associated with poor outcome. Spatial neglect is clinically defined as a deficit in processing and responding to stimuli presented on the contralesional side of the body, or the space surrounding that side of the body. The heterogenetic, multi-sensory nature of the symptoms renders it difficult to diagnose and treat; therefor effective methods for screening and intervention for neglect are needed. Virtual reality (VR) is a method of brain–computer interaction that involves realtime simulation of an environment, scenario or activity that allows for user interaction and targets multiple senses. We hypothesize that VR can facilitate identification of spatial neglect in stroke patients and that training with this interface will improve patient’s functional outcome, through stimulation to neuronal networks including those controlling attention. Objective: The objective was to construct and validate a computerized test battery for spatial neglect and to investigate its usability in stroke patients. Also to design and develop a VR rehabilitation method for spatial neglect and to evaluate its effects on spatial attention and on neuronal activity in the brain. Method: We designed, developed and evaluated a new concept for assessment (VR-DiSTRO®) and training (RehAtt®) of spatial attention, using VR technology. The hardware consisted of a PC, monitor, 3D-glasses and a force feedback device to control the tasks (i.e., a robotic pen). The software enabled targets to be moved, rotated and manipulated in the 3D environment using the robotic pen. RehAtt® made it possible to combine intense visual scanning training, multi-sensory stimulation (i.e., audio, visual, tactile) and sensory-motor activation of the contralesional arm. In a first study on 31 stroke patients we performed a construct validation of VR-DiSTRO® against Rivermead Behavioural Test Battery (BIT) and investigated the usability. In a second study, 15 subjects with chronic spatial neglect (symptoms >6 month) had self-training, 3 x 1 hour for 5 weeks using RehAtt®. Outcome were measured by changes in neglect tests and in Cathrine Bergego Scale (CBS). Training-related changes in neuronal activity of the brain was studied using fMRI during task and in resting state. Results: VR-DiSTRO® correctly identified all patients with neglect. The sensitivity was 100% and the specificity 82% for VR-DiSTRO® compared to BIT. Usability was high and no side-effects were noted. Using repeated measurement analysis, improvements due to the RehAtt® intervention were found for Baking tray task (p < 0.001), Star cancellation test (p = 0.006) and Extinction test (p = 0.05). Improvements were also seen in the Posner task as fewer missed targets (p = 0.024). Improvement in activities of daily living (CBS) was shown immediately after training (p < 0.01) and patients still reported improvement at 6 months follow-up. Trainingrelated changes in neuronal activity were seen as an increased task-evoked brain activity in prefrontal and temporal cortex, mainly outside the attention network but in related cortical areas. During resting state, changes in network connectivity were seen after intervention with RehAtt® in the Dorsal Attention Network (DAN) and interhemispheric connectivity. Conclusion: VR-DiSTRO® identified visuospatial neglect in stroke patients quickly and with a high accuracy. RehAtt® training improved in spatial attention in chronic neglect with transfer to functions in daily living. Increased neuronal brain activity was found in and between attention networks and related brain structures. This could represent a compensatory effect in addition to sign of a restorative effect from the RehAtt training. The results obtained in this study are promising, encourage further development of the methods and merit for further studies.

Introduktion: Stroke kan vara ett mångfacetterat och komplext tillstånd. Uppresningar från stol speglar en fundamental aktivitet i det dagliga livet. Uppresningsförmågan är delvis avhängig en individs benstyrka, vilken i regel försämras med stigande ålder. Stroke drabbar oftast äldre individer, och påverkar ofta uppresningsförmågan negativt. Det är därför viktigt att kunna utvärdera uppresningsförmågan med valida och reliabla utvärderingsinstrument. Uppresningstestet 30 sekunder Chair Stand Test (30 CST) kan användas för detta, men har inte validitetstestats för populationen stroke. Syfte: Studiens syfte var att utföra en begreppsvalidering av 30 CST för patienter med akut stroke genom att undersöka hur testet korrelerar med greppstyrka, Timed up and go (TUG), Step test (ST) och Functional ambulation category (FAC). Metod: Tvåhundrasextioåtta individer med nytillkommen stroke inneliggande på tre olika slutenvårdsavdelningar i Sverige inkluderades i studien under 2016-2017. Studiedeltagarna utförde 30 CST, test av greppstyrka, TUG, ST och FAC. I syfte att begreppsvalidera 30 CST testades sambandet mellan 30 CST och de andra instrumenten med Spearmans rangkorrelation. Resultat: 30 CST korrelerade signifikant med greppstyrka (svagaste handen ρ=0,538, p<0,001, starkaste handen ρ=0,459, p<0,001), TUG (ρ=-0,705, p<0,001), ST (svagaste sidan ρ=0,875, p<0,001, starkaste sidan ρ=0,879, p<0,001) och FAC (ρ=0,772, p<0,001). Konklusion: Utvärderingsinstrumentet 30 CST begreppsvaliderades för patienter i akut fas efter stroke. 30 CST och ST samt 30 CST och FAC hade bra korrelation, medan 30 CST och TUG hade moderat korrelation. Greppstyrka hade dålig till måttlig korrelation med 30 CST. Utvärderingsinstrumenten utvärderar liknande kroppsliga förmågor, och där förmågorna är mer lika varandra, påträffades också högre korrelationskoefficienter.

Parkinson’s disease is a common neurological disease which will progressively damagedopaminergic neurons in the brain. Later stages of the disease will result in death of theneurons. The diagnosis is often made with respect to the motor symptoms, which includetremors, bradykinesia, and rigidity. In addition to motor symptoms, non-motor symptomsappear in many patients, such as cognitive changes and mood disorders. One method used totreat Parkinson’s disease is deep brain stimulation, where electric pulses are emitted to aspecific brain area. A common target is the subthalamic nucleus, which is part of the basalganglia. By using deep brain stimulation, the dose of other medications for Parkinson’sdisease can be lowered. However, the mechanisms of deep brain stimulation are not yetentirely known, and there have been many reports of adverse side-effects caused by thismethod, including depression and other types of mood changes. Even so, information of apossible sex distribution of these side-effects is still limited. Here, a qualitative essay wasmade where 16 articles describing reported side-effects in men and women were compared. Inaddition, unpublished data from optogenetic studies on male and female mice were analysedin order to examine putative sex-differences upon experimental brain stimulation strategies.The results from the optogenetics results did not show any statistically significant sexdifferences.In contrast, by comparing the selected articles in which results of deep brainstimulation treatment in patients were reported, some differences were found. First, it seemsthat women report more depressive-like symptoms than men. Second, while men also reportdepressions, they also report more aggressive behaviour upon the treatment. A preliminaryconclusion of this essay is therefore that certain sex-differences can be observed among theadverse side-effects reported upon deep brain stimulation in Parkinson´s disease. However,since the studied material was limited, more research is required to make firmer conclusions.

Parkinson’s Disease is a degenerative neurological disease where dopaminergic neurons in the basal ganglia degenerate and die. This leads to dopamine deficiency in the basal ganglia, affecting both motor and non-motor systems, giving both motor and non-motor symptoms. Common non-motor symptoms in Parkinson’s disease are depression, anxiety and apathy. Exercise have shown to be effective in decreasing depression in otherwise healthy people. The aim of this degree project was to examine if exercise can act as a treatment against impaired mood for people with Parkinson's disease. Nine trials investigating the effect of different types of training with different duration and different exercise intervals were selected and studied. By comparing the results obtained in these trials, it was found that in seven of the nine studies, exercise have had a positive effect on depression. Fewer studies had examined anxiety and apathy, and the effect of exercise was not as clear. Anxiety decreased in two of three studies and apathy decreased in one of three. The studied material is limited but the conclusion that can be drawn from this study, is that exercise is a safe way to, without negative side effects, treat and/or counteract mood disorders including depressive symptoms in Parkinson’s disease, mild to moderate stage.

Bakgrund: Multipel skleros är en neurologisk sjukdom som drabbar det centrala nervsystemet. Sjukdomen har störst prevalens i västerländsk kultur men etiologin är ännu inte klarlagd. Symtomen är individuella med funktionsnedsättningar i den fysiska likväl som den kognitiva förmågan. Syfte: Syftet var att beskriva vuxnas upplevelse av att leva med multipel skleros. Metod: En kvalitativ litteraturstudie med induktiv ansats genomfördes och analyserades enligt Granheim och Lundmans (2004) modell. Resultat: Analysen resulterade i fyra huvudkategorier som beskriver upplevelsen av att leva med multipel skleros: en förändrad kropp, farhåga för sjukdomens exponering och utveckling, behov av stöd och viljan att leva. Resultatet påvisade att de MS-drabbade personerna upplevde både fysiska och kognitiva begränsningar och anpassade därför livet efter sjukdomen för att hantera sitt tillstånd. Slutsats: Multipel skleros varierar i symtombild och förändrar hur kroppen upplevs. Begränsningarna som MS medförde innebar anpassningar i arbete, vardag och fritid. Det framkom också att MS-drabbade personer upplevde rädsla att tillståndet missuppfattas och en oro inför framtiden. De MS-drabbade strävade efter att uppnå hälsa trots sjukdom genom att omprioritera mål i livet och visa hänsyn till kroppens begränsningar. Resultatet kan bidra till vara stöd för hälso- och sjukvårdspersonal att få en insikt i MS-drabbade personers upplevelser, för att på så vis förbättra omvårdnaden för dessa.

Introduction: Guillain-Barré syndrome (GBS) is a neurological disease caused by an autoimmune attack on the peripheral nerves. The main symptoms are loss of motor and sensory skills in the upper and lower extremities. Autonomic dysfunction also occurs.Aim: To identify which parameters in neurography examination that are showing pathology at three different stages from the onset of symptoms. To practically perform and evaluate different electrode placements at RR-intervals.Materials and methods: The first part of this study was a retrospective study with results from 58 patients which were diagnosed with GBS in 2010-2020 at the University Hospital in Uppsala. The second part of this study included measurement of the heart rate variation with RR-intervals at different electrode placement in ten healthy volunteers. Results: In part 1 of the project, there were no significant differences between the groups at distal latency in the ulnar nerve, F-latency in the tibial nerve and in the conduction velocity in the sural nerve. However, there were significant differences in the amplitude of the radial nerve. In part 2 of the project, there were significant differences between the electrode placements, and most artifacts were found with electrodes placed on the shoulders.Conclusion: Examination with neurography and RR-intervals plays an important role in the diagnosis of GBS. As the amplitude in the radial nerve was the only one that showed significant differences between the groups, the nerve is recommended to be examined bilaterally. With a high presence of artifacts in RR-intervals with electrodes placed on the shoulders and wrists, placement on the chest is to be recommended.

Bakgrund: Antalet personer som drabbas av en stroke ökar över hela världen och därmed ställs sjukvården inför en fortsatt utmaning att utveckla och modernisera rehabiliteringen för strokepatienter.  Syfte: Att granska och syntetisera litteratur om hur strokepatienter upplever Virtual Reality (VR) i rehabiliteringen och dess möjliga inverkan på aktivitetsförmågan i det vardagliga livet.  Metod: En systematisk litteraturöversikt för att granska och sammanställa litteratur. Databaserna som använts för insamlingen av artiklarna är CINAHL, Medline, PubMed, Taylor & Francis Journals, AMED och PsycInfo, vilket resulterade i 9 studier. Granskningen av artiklarna utfördes enligt SBU:s granskningsmodell för bedömning av studier med kvalitativ metodik. Efter kvalitetsgranskningen gjordes en metasyntes av de inkluderade artiklarna för att uppfylla studiens syfte.  Resultatet: Litteraturöversikten innehåller 9 studier med utgivningsår 2015–2022. Metasyntetiseringen ledde till 24 första nivåns teman samt fyra andra nivåns teman: ” VR skapar positiva och negativa upplevelser” ,”Upplevda fördelar och brister vid utnyttjande av VR bland strokepatienter”, ”Förbättring av funktionsförmågan i vardagen med hjälp av VR” och ”Vikten av sammanhang och stöd betonas”. En analys av andra nivåns teman resulterade i två tredje nivåns teman: ” VR väcker intresse, men har såväl fördelar som nackdelar” och ”VR:s betydelse i vardagen och det sociala för strokepatienter”.  Slutsats: Genomgången av materialet resulterade i 9 studier. På basen av studierna framkom bland annat att strokepatienter har både positiva och negativa upplevelser av VR. Studierna visar också att det finns ett behov av fortsatta kvalitativa studier inom ämnet, vilka fokuserar på strokepatienter och deras upplevelser av VR, för att bidra till en ökad kunskap om ämnet ur ett arbetsterapeutiskt perspektiv. / Background: The number of people who suffer a stroke is increasing all over the world, and thus the healthcare system is faced with a continuing challenge to develop and modernize the rehabilitation for stroke patients.  Aim: To review and synthesize literature on how stroke patients experience Virtual Reality (VR) in rehabilitation and its possible impact on the ability to perform activities in everyday life.  Method: A systematic literature review to review and compile literature. The databases used for the collection of the articles are CINAHL, Medline, PubMed, Taylor & Francis Journals, AMED and PsycInfo, which resulted in 9 studies. The review of the articles was carried out according to the SBU’s review model on assessment of studies with qualitative methodology. After the quality review, a meta-synthesis was made of the included articles to answer the purpose of the study.  The result: The literature review contains 9 studies with publication years 2015–2022. The meta- synthesis led to 24 first-level themes and four second-level themes: "VR creates positive and negative experiences", "Perceived advantages and disadvantages of using VR among stroke patients", "Improvement of functional ability in everyday life with the help of VR" and "The importance of context and support are emphasized”. An analysis of the second-level themes resulted in two third-level themes: "VR arouses interest, but has advantages as well as disadvantages" and "VR's importance in everyday life and social life for stroke patients".  Conclusion: The review of the material resulted in 9 studies. On the basis of the studies, positive and negative experiences of VR in stroke patients emerged, among other things. Based on the study, there also remains a need for continued qualitative studies within the subject, which focus on stroke patients and their experiences of VR in order to contribute to an increased knowledge of the subject from an occupational therapy perspective.

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