Browsing by Author "Dahlgren, Annika"

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    Quality assessment of ADL instrument and evaluation of ADL ability in individuals with cervical spinal cord injury after reconstructive hand surgery
    (2017-04-28) Dahlgren, Annika
    Abstract Background: A spinal cord injury (SCI) leads to dramatic changes in an individual’s life and the rehabilitation after the injury is a lifelong process. For persons with cervical spinal cord injury (SCI), the loss of both sensory and motor function in the upper extremities poses a functional deficit and an impairment in activities of daily living (ADL). Reconstructive hand surgery has the potential to restore loss of motor function and can therefore influence both capacity, i.e. grip function, and activity performance. Methods: One cross-sectional study, one mixed study and two longitudinal studies were performed. The study participants consisted of individuals with cervical spinal cord injury with no prior reconstructive hand surgery before September 1994. Data were collected by face-to-face semi-structured interviews and by connecting the Klein-Bell ADL (KB) Scale to the ICF. Results: The KB Scale linkage to the ICF made it possible to interpret, detect and quantify concepts in the scale and thus highlighted and clarified the scale structure. Comparison between the KB Scale and ICF core sets and have corroborated that the scale can measure basic ADL in individuals with cervical SCI. The KB Scale can be used to assess and discriminate cervical SCI individuals’ basic ADL from lesser to greater independence before surgery. Improvements in basic ADL can also be measured after reconstructive hand surgery. Individuals undergoing grip reconstruction became more independent in dimension hygiene, whereas individuals undergoing reconstructive elbow extension and grip surgery increased their independence in dimension mobility. Conclusions: The ICF provided an external reference to identify and quantify concepts in the KB Scale. The KB Scale linkage to ICF provided a systematic overview how the items are constructed from body movements to basic ADL activities. The KB Scale can be used to assess basic ADL, and discriminate and measure changes in self-care in cervical SCI individuals in connection with reconstructive hand surgery. To become a useful tool, selected parts of the KB Scale’s structural properties must be further investigated.
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    Reconstructive upper limb surgery in patients with cervical spinal cord injury. Evaluation of postoperative treatments and examination of applicability of the Klein-Bell ADL Scale
    (2009-02-03T10:08:15Z) Dahlgren, Annika
    Aims: Studies I & II: To describe and evaluate postoperative deltoid-triceps protection of tendon elongation and long-term clinical follow-up after tenodesis to the IP joint of the thumb. Study III: To examine and explore the applicability of the Klein-Bell ADL Scale (KB Scale) in patients with cervical spinal cord injury in terms of daily activities and the association between basic ADL and upper extremity function. Method: Studies I & II data were collected retrospectively. Eleven patients were included in study I. The patients were divided postoperatively into two groups; patients using their manual wheelchair without a special armrest and patients using an electric power driven wheelchair with a special armrest. Stainless steel sutures (markers) were placed proximally and distally of the tendon-to-tendon attachment sites. The distances between markers were measured via upper extremity x-ray to evaluate tendon elongations. Thirtythree patients were included in study II. Extension, flexion and range of motion were measured to evaluate how the tenodesis of the IP joint of the thumb influenced the different movement modalities of the IP joint of the thumb. Study III: Data were collected prospectively. Fifty-five patients were included in the study. Assessments of the patients’ independence were made according to the K-B Scale. Three more analyses were performed; the first analysis was made to examine whether assistive devices and car and house adaptations could influence the patient’s independence. The last two analyses included investigations of whether arm and different grip functions and different grip phases could be detected in the items’ operational criteria. Results: In study I the total distances between markers after reconstruction of deltoid to triceps were significantly lower in the patients using an electric power driven wheelchair with special armrest compared to those without the armrest. The largest difference in tendon elongation between the groups occurred in the proximal tendon transfer. Elbow extension deficit was decreased in the group using the electric power wheelchair with an armrest, although not significantly as compared to those without the armrest. In study II treatment with a thumb splint after tenodesis to the IP joint of the thumb gave a pliable and well balanced IP joint with comparable results in extension, flexion and ROM at six months and 12 months postoperatively. In study III only the raw sum score and not the weight scheme in the K-B scale discriminated the patient’s independence in daily activities (ADL). Assistive devices and car and house adaptations made the patients more independent. Lack of grip function decreased the patient’s ability to become independent. Conclusion: The use of an electric power driven chair with a special armrest and thumb splint has shown that relatively simple adjuncts can positively influence the effectiveness of operations performed. The cooperation between the hand surgeons and the therapist to develop these treatments has been important for improved results in these studies. The K-B Scale can be used to assess basic ADL and can discriminate between cervical SCI patients’ independence in ADL. To become a useful tool, the K-B Scale’s structural properties in conjunction with arm and grip function must be further investigated.