The prevalence of spasticity after first-ever stroke is approximately 20%, but there are no data on the prevalence of disabling spasticity.The reported prevalence of pain after stroke varies between 19% and 74%, whether pain is associated with spasticity is not known. Until now, there is no health economic analysis of patients with spasticity after stroke. Methods: Two groups of patients were studied. Cohort I was a cross-sectional survey. A representative sample of 140 patients was investigated 1 year after their first-ever stroke. Spasticity was defined as ≥ 1 score on the modified Ashworth scale, disabling spasticity was defined as spasticity having such an impact that intervention, e.g. intensive physiotherapy, orthoses or pharmacological treatment, should be offered. Pain was assesed with the Visual Analogue Scale. All direct costs during one year were identified and converted into Purchasing Power Parities US dollar (PPP$). Cohort II was a prospective cohort study. Forty-nine patients were examined at day 2–10, at one month, and at six months after their first-ever stroke. Assessment and definitions were similar as for cohort I. Results: Spasticity occurs within 1 month and disabling spasticity occur within 6 months. After one year, the prevalence of spasticity was 17% and that of  disabling spasticity 4%. Disabling spasticity was more frequent in the upper extremity. There was an independent effect of severe upper extremity paresis (OR 22, CI 3.9–125) and age below 65 years (OR 9.5, CI 1.5–60). The prevalence of stroke-related pain was 21% after one year. Stroke-related pain was associated with paresis (OR 3.1, 95% CI 1.2–7.7), sensory disturbance (OR 3.1, 95% CI 1.1–8.9) and depression (OR 4.1, 95% CI 1.4–13), but not with spasticity as an independent variable. The majority of the direct costs for one year (78%) were associated with hospitalization, whereas 20% was associated with municipality services. Only 1% of all direct costs were related to primary health care and 1% to medication. The mean (median, inter-quartile range) direct cost for stroke patients with spasticity was PPP$ 84 195 (72 116, 53 707) compared to PPP$ 21 842 (12 385, 17 484) for stroke patients without spasticity (P < 0.001).

Hand exoskeletons are wearable robotic devices which are used to compensate for impaired handmovements in patientswith impaired upper-limbs. These devices can either help patients to grasp objects for a therapeutic purpose or to performactivities of daily living. This Thesis describes the development of a novel hand exoskeleton, with a focus on the user, based on the product development methodology "the V-Model". Therefore, user needs are identified through interviews and a thorough literature review. Three potential concepts are developed and sub-sequential a concept is selected based on a logical decision process. A mathematical model of the selected concept is generated and then used for dimensioning the hand exoskeleton. Moreover, three variants of the hand exoskeleton are built as prototypes. Finally, the variants of the device are tested on a bench top. The result of the development process is a novel hand exoskeleton for the rehabilitation of upper motor neuron syndrome patients. Force and range of motion tests revealed, that a design with a higher level of underactuation is favourable. The design presented in this thesis does not reach the defined range of motion and force augmentation. However, the defined target values are the results of a conservative approach, thus are a challenge to reach. The augmented closing force and range of motion surpass other state of the art hand exoskeletons. Nevertheless, the augmented opening force under-performs in comparison with other designs. Decisively, a validation with users is needed for a usability assessment. / Exoskelett för händer är robotiska hjälpmedel som kan användas för att kompensera nedsatt muskelstyrka och rörlighet hos patienter med nedsatt muskelfunktion i armarna. Dessa hjälpmedel kan hjälpa patienter att greppa föremål i ett terapeutiskt syfte eller för att utföra vardagliga sysslor. Examensarbetet beskriver utvecklingsarbetet av ett nytt exoskelett med fokus på användaren genom att tillämpa produktutvecklingsmotodikens V-modell. Användarens krav och behov identifieras genom intervjuer och en gedigen litteraturstudie. Tre koncept utvecklas och ett vidareutvecklat koncept väljs slutligen baserat på en logisk beslutsprocess. En matematisk modell genereras och används för att dimensionera exoskelettet. Dessutom tillverkas tre prototyper av exoskelettet i olika utföranden för att slutligen utvärderas i en testrigg. Resultatet av utvecklingsprocessen är ett nytt handexoskelett ämnat för rehabilitering av patienter med övre motorneuronsjukdom. Tester som genomfördes för att mäta Kraft och rörlighet visade att en design med en högre grad av underaktuering är gynnsamt. Designen som presenteras här når inte upp till de krav som ställs på kraft och rörlighet, de målvärden som definieras är dock baserade på ett konservativt synsätt och är därmed svåra att uppnå. Exoskelettet producerar en högre stängningskraft och uppvisar bättre rörlighet än andra toppmoderna exoskelett. Exoskelettet underpresterar dock vad gäller den producerade öppningskraften jämfört med andra modeller och designen behöver valideras hos användarna för att användarbarheten ska kunna bestämmas.

A large proportion of patients with central motoneuron lesions is at risk of spastic paresis and formation of contractures. One of the therapeutic techniques used in patients with spastic paresis is prolonged stretching. The theoretical part summarizes the knowledge regarding spastic paresis, its clinical evaluation, the development of contractures and therapeutic interventions, especially botulinum toxin (BTX) and stretching. The aim of this study was to compare the effectiveness of prolonged stretching on spastic muscle contracture before and after BTX application. In our retrospective comparative study there were included 30 patients divided into two groups. The first group consisted of 15 patients performing prolonged stretching of the m. rectus femoris (m. RF) for three months according to Guided Self-rehabilitation Contract of Professor J. M. Gracies. The second group (15 patients) performing the same procedure, but at the same time BTX was injected into the m. RF. We monitored the change in passive knee joint range of motion into flexion and the change in 10MWT time. Statistical evaluation showed that the difference in knee joint range of motion after three months of performing prolonged stretching was statistically insignificant (p=0.194). The difference in knee joint range of motion after...