Leisure time physical activity among older adults with long-term spinal cord injury.

STUDY DESIGN: Cross-sectional. OBJECTIVES: To describe participation in leisure time physical activity (LTPA) (amount, intensity and type) among older adults with long-term spinal cord injury (SCI), and to investigate the associations with sociodemographics, injury characteristics and secondary health conditions (SHCs). SETTING: Home settings in southern Sweden. METHODS: Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). The physical activity recall assessment for people with SCI was used to assess LTPA among 84 men and 35 women (mean age 63.5 years, mean time since injury 24 years, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D). Associations were analyzed statistically using hierarchical multivariable regression. RESULTS: Twenty-nine percent reported no LTPA, whereas 53% performed moderate-to-heavy intensity LTPA. The mean minutes per day of total LTPA was 34.7 (±41.5, median 15, range 0-171.7) and of moderate-to-heavy LTPA 22.5 (±35.1, median 5.0, range 0-140.0). The most frequently performed activities were walking and wheeling. Sociodemographics, injury characteristics and SHCs (bowel-related and bladder-related problems, spasticity and pain) explained 10.6% and 13.4%, respectively, of the variance in total and moderate-to-heavy LTPA. Age and wheelchair use were significantly, negatively associated with total LTPA. Women, wheelchair users and employed participants performed significantly less moderate-to-heavy LTPA than men, those using walking devices/no mobility device and unemployed participants. CONCLUSION: Many older adults with long-term SCI do not reach the amount or intensity of LTPA needed to achieve fitness benefits. Research is needed on how to increase LTPA and to identify modifiable factors that could enhance their participation.

Vocational outcome 6-15 years after a traumatic brain injury.

PRIMARY OBJECTIVE: To describe vocational outcome 6-15 years after a traumatic brain injury (TBI) among individuals who were productive by working or studying at the time of their TBI and determine the associations with variables related to the time of injury and at follow-up. METHODS AND PROCEDURES: Thirty-four individuals with a mild TBI and 45 with a moderate-to-severe TBI were assessed on average 10 years post-injury. Logistic regression was used to determine the association between their current vocational situation and variables related to the time of injury (gender, age, injury severity and educational level) and at follow-up (time since injury, marital status and overall disability). RESULTS: A total of 67% were productive at follow-up. Age at injury, injury severity and the degree of disability at follow-up were strongly associated with being productive. Younger individuals with milder TBI and less severe disability were significantly more likely to be fully productive. No significant associations were found between productivity and gender, education, time since injury or marital status. CONCLUSIONS: This study indicates that return to productivity in a long-term perspective after a TBI is possible, in particular when the individual is young, has sustained a mild TBI and has a milder form of overall disability.

Psychometric properties of the Satisfaction With Life Scale in Parkinson's disease.

OBJECTIVE: The Satisfaction With Life Scale (SWLS) is a global measure of life satisfaction (LS). The objective of this study was to evaluate the psychometric properties (data completeness, scaling assumptions, targeting and reliability) of the SWLS in a sample of people with Parkinson's disease (PD). MATERIALS AND METHODS: A postal survey including a Swedish version of the SWLS and demographic information was administered to 174 persons with PD; 97 responded and received a second survey after 2 weeks. RESULTS: The mean (SD) age and PD duration of the 97 responders were 73 (8) and 7 (6) years, respectively. Data completeness was 92% to 97% for the five items in the SWLS and 92% for the total score (5-35 points). The mean score of the SWLS was 24.2 points (7.7), indicating that this group had an average LS. The items' means and SDs were roughly parallel and the score distribution was even. The internal consistency reliability (Cronbach's alpha) was 0.90. The test-retest reliability, assessed by the intraclass correlation coefficient, was 0.78. The scale showed no systematic difference between the first and second response. The standard error of measurement was 3.6 points, and the smallest detectable difference was 10.0 points. CONCLUSIONS: This evaluation of the psychometric properties of the SWLS shows that the scale has good data completeness, scaling assumptions and targeting and that the internal consistency reliability and the test-retest reliability are acceptable. Thus, the SWLS is a psychometrically sound and suitable tool to asses LS in people with PD.

Sports-related injuries in athletes with disabilities.

The number of athletes with disabilities participating in organized sports and the popularity of the Paralympic Games is steadily increasing around the world. Despite this growing interest and the fact that participation in sports places the athlete at risk for injury, there are few studies concerning injury patterns, risk factors, and prevention strategies of injuries in disabled athletes. In this systematic literature search and critical review, we summarize current knowledge of the epidemiology of sports-related injuries in disabled athletes and describe their characteristics, incidence, prevalence, and prevention strategies. The outcomes of interest were any injury, either an acute trauma or an overuse event. PubMed, EMBASE, CINAHL, and Google Scholar were systematically searched and 25 of 605 identified studies met the inclusion criteria. Lower extremity injuries were more common in walking athletes, whereas upper extremity injuries were more prevalent in wheelchair athletes. The methodologies and populations varied widely between the studies. Few studies were sports or disability specific, which makes it difficult to determine specific risk factors, and few studies reported injury severity and prevention of injuries. Further longitudinal, systematic sports and disability specific studies are needed in order to identify and prevent injuries in athletes with disabilities.

Preparing for snow-sport events at the Paralympic Games in Beijing in 2022: recommendations and remaining questions.

During the 2022 Winter Paralympic Games in Beijing, the Para snow-sport events will be held at high altitudes and in possibly cold conditions while also requiring adjustment to several time zones. Furthermore, the ongoing COVID-19 pandemic may lead to suboptimal preparations. Another concern is the high rate of injuries that have been reported in the Para alpine and snowboard events. In addition to these challenges, Para athletes various impairments may affect both sports-specific demands and athlete health. However, the group of Para snow-sport athletes is an understudied population. Accordingly, this perspective paper summarises current knowledge to consider when preparing for the Paralympic Games in Beijing and point out important unanswered questions. We here focus specifically on how sport-specific demands and impairment-related considerations are influenced by altitude acclimatisation, cold conditions, travel fatigue and jetlag, complications due to the COVID-19 pandemic, and injury prevention and sports safety considerations. As Para athletes with spinal cord injury, limb deficiency, cerebral palsy and visual impairment account for the majority of the Para snow-sport athletes, the focus is mainly on these impairment groups. In brief, we highlight the extra caution required to ensure athlete health, performance and sports safety among Para athletes participating in the snow-sport events in the 2022 Beijing Paralympic Games. Although there is an urgent need for more high-quality research focusing on Para winter athletes, we hope these non-consensus recommendations will help prepare for the 2022 Beijing Paralympic Winter Games.

Sense of coherence and disability and the relationship with life satisfaction 6-15 years after traumatic brain injury in northern Sweden.

The objective of the study was to assess sense of coherence (SOC) many years after traumatic brain injury (TBI) and explore the relationship between SOC and self-rated life satisfaction (LS) as well as measures of functioning and disability, sex, age at injury, injury severity and time post-injury. Sixty-six individuals (aged 18-65 years) who were 6-15 years post-injury were interviewed. Data on SOC (SOC-13 item scale), measures of functioning and disability (Mayo-Portland Adaptability Inventory, MPAI-4), LS (Satisfaction with Life Scale, SWLS), and sex, age at injury, injury severity and time post-injury were analysed with hierarchical multiple regression analyses. The results showed that SOC in the study group did not differ from the general population and was strongly associated with LS. Regression analyses revealed that emotional factors, social participation, SOC, and time since injury, were more influential than sex, age at injury, and injury severity in explaining LS. It was concluded that SOC in this group of individuals with TBI who were many years post-injury was similar to nondisabled individuals. SOC, together with emotional factors, social participation and injury-related factors, were determinants of LS. These results confirm that LS after TBI is a complex phenomenon dependent on several factors that are important targets for rehabilitation professionals.

Health-related quality-of-life and life satisfaction 6-15 years after traumatic brain injuries in northern Sweden.

OBJECTIVE: To describe health-related quality-of-life (HRQoL) and life satisfaction many years after a traumatic brain injury (TBI) and assess possible associations with variables related to the time of injury and follow-up and the individuals' self-appraisal of the impact of the TBI. METHOD: Sixty-seven individuals (18-65 years), on average 10 years post-injury, were interviewed. Data on HRQoL, using the SF-36 questionnaire, were compared with a Swedish age- and sex-matched reference sample, and life satisfaction, using the Satisfaction With Life Scale (SWLS), were compared with a nationwide Swedish sample of students. The participant's self-appraisal of the TBI was assessed with two supplementary questions. Data were analysed with hierarchical multiple regression analyses. RESULTS: HRQoL as well as life satisfaction were lower compared with the reference samples. From the regression analyses, the individuals' own appraisal of the impact of the TBI and whether they were vocationally productive or not were strongly associated with their current physical health and life satisfaction. CONCLUSION: These results confirm the importance of TBI as a cause of long-term disability and the impact of the injury on the individuals' self-perceived values of health, quality-of-life and life satisfaction.

Functioning and disability 6-15 years after traumatic brain injuries in northern Sweden.

OBJECTIVES: To assess long-term functioning and disability after traumatic brain injury (TBI). MATERIAL AND METHODS: Individuals (n = 88) in Norrbotten, northern Sweden, who had been transferred for neurosurgical care were assessed with internationally established TBI outcome measures 6-15 years post-injury. RESULTS: There was an improvement in overall outcome from discharge from inpatient rehabilitation to follow-up. Many individuals had a high degree of motor and cognitive functioning, which enabled them to live independently in their own home without assistance, but there remained a disability related to community reintegration and social participation. This affected their productivity and to some degree their marital stability. The remaining disability and reduced productivity were related to the age at injury and the injury severity. CONCLUSIONS: Our data showed that individuals with a TBI can achieve and maintain a high degree of functioning many years after the injury. Increasing age and a greater injury severity contributed to their long-term disability.

Effects of a goal-oriented rehabilitation program in mild cognitive impairment: a pilot study.

BACKGROUND: Memory disturbance, deficient concentration, and fatigue are symptoms seen in amnestic mild cognitive impairment (MCI) as well as in mild traumatic brain injury (TBI). The aim of this study was to assess if an established rehabilitation program commonly used in TBI can aid MCI patients to develop compensatory memory strategies that can improve their cognition, occupational performance, and quality of life (QoL). METHODS: Fifteen patients with MCI participated in the program 2 days per week for 8 weeks. Cognitive function, occupational performance, and self-perceived QoL were assessed at baseline, at the end of the intervention, and at follow-up after 6 months. RESULTS: Significant improvements were seen in cognitive processing speed, occupational performance, and in some of the QoL domains. CONCLUSION: As this goal-oriented rehabilitation program in MCI resulted in some improvements in cognition, occupational performance, and QoL, further randomized controlled studies are warranted.

Muscle strength training, gait performance and physiotherapy after stroke.

UNLABELLED: Hemiparesis after stroke, with muscle weakness and reduced gait performance, is a leading cause of long-term disability. To improve lower limb muscle strength and mobility post stroke, there is a need for effective training METHODS: This review summarises the effects of lower limb progressive resistance training ([PRT]; loads of 70% or more of the maximum strength) on muscle strength, muscle tone, gait performance and perceived participation after stroke. PRT is a safe and effective way to improve muscle strength post stroke, without negative effects on muscle tone. Furthermore, improvements in muscle strength positively influence gait performance and perceived participation. Current recommendations for stroke rehabilitation include strength training, which can also be an effective form of fitness training for subjects with minor weakness. Despite its proven effectiveness, further studies are needed to find the most appropriate time to start PRT post-stroke, to identify those stroke individuals that can benefit most from PRT and how to combined PRT with other physiotherapeutic stroke interventions.

Vocational situation and experiences from the work environment among individuals with neuromuscular diseases.

BACKGROUND: Neuromuscular diseases (NMD) can affect the ability to be employed and to work, but there is limited knowledge of individuals' own perspectives of factors that are important for their vocational situation. OBJECTIVE: To explore the vocational situation among people with NMD that are employed, and to describe their experiences of how their disability, personal and environmental factors influence their ability to continue to work. METHODS: Nine participants with different NMD were included. A mixed-methods design was used, and data were collected by means of semi-structured and open-ended interviews, and ratings of aspects supporting or interfering with their work performance and the ability to continue to work. Data were analyzed with directed content analysis based on the International Classification of Functioning, Disability and Health, and with descriptive statistics. RESULTS: The participants' personal characteristics, support from others at work and at home, and a flexible work organization were perceived as important factors facilitating work continuation, whereas physically demanding work assignments and factors in the physical environment were perceived as barriers. CONCLUSIONS: Knowledge of how personal characteristics as well as support from the work organization, managers and family members can facilitate the ability to work is important for employers, staff within different parts of the health care system, and the social security system. Future research should focus on interventions that are best suited to enhance the vocational situation for individuals with NMD.

Human aging, muscle mass, and fiber type composition.

To assess the age-related loss of muscle mass and to determine the mechanisms behind this aging atrophy, the muscle structure and fiber type composition have been estimated, using invasive and noninvasive techniques. Limb muscles from older men and women are 25-35% smaller and have significantly more fat and connective tissue than limb muscles from younger individuals. Comparisons of muscle biopsies from younger and older individuals reveal that type 2 (fast-twitch) fibers are smaller in the old, while the size of type 1 (slow-twitch) fibers is much less affected. Studies of whole muscle cross sections also show a significantly smaller number of muscle fibers, a significantly lower relative type 2 fiber area, and a significant increase in fiber type grouping with increasing age. These results indicate a gradual decrease in size/volume with advancing age, accompanied by a replacement by fat and connective tissue. This aging atrophy seems to be due to a reduction in both number and size of muscle fibers, mainly of type 2, and is to some extent caused by a slowly progressive neurogenic process.

Skeletal muscle fatigue and endurance in young and old men and women.

The effects of increasing age on skeletal muscle fatigue and endurance were assessed in 22 healthy young (14 men and 8 women; mean age, 28 +/- 6 years) and 16 healthy old (8 men and 8 women; mean age, 73 +/- 3 years) individuals. All subjects performed 100 repeated maximum dynamic knee extensions at 90 degrees.s-1 (1.57 rad.s-1) using an isokinetic dynamometer (Cybex II). Peak torque was recorded during every contraction, and for each individual the maximal voluntary contraction (MVC), the fatigue rate, the endurance level, and the relative reduction in muscle force were determined. MVC and endurance level were significantly lower in old men and women, but there was no discernible difference in relative muscle force reduction and fatigue rate between young and old individuals. We conclude that thigh muscles of older individuals are weaker than those of younger individuals, but relative to their strength, older individuals have similar properties as younger individuals with respect to muscle fatigue and endurance.

Analysis of sampling errors in biopsy techniques using data from whole muscle cross sections.

Because of the large variability in the proportion of fiber types within a whole muscle, a single biopsy is a poor estimator of the fiber type proportion for a whole muscle. Data on the proportions of type I and II fibers, obtained from cross sections of whole human muscles (vastus lateralis) from young male individuals, have therefore been analyzed statistically in order to determine the sampling errors involved in muscle biopsy techniques. For the purpose of obtaining a good estimate of the fiber type proportion in a whole biopsy, counting all fibers is of great benefit compared with counting only half of the fiber number. The required number of biopsies to obtain a given sampling error of the mean proportion of fiber types in the whole muscle can vary by a factor of six. If less than three biopsies are taken from a muscle, there is a substantial reduction in sampling error taking biopsies with at least 600 fibers. For more than three biopsies there is a small gain in sampling greater than 150 fibers. The precision of the estimate of the mean proportion of fiber types for a group is increased with the number of biopsies per individual and number of individuals. In conclusion, for the muscle in this study, complete counting of three biopsies, each greater than 150 fibers, sampled from different depths of the muscle is recommended.

Capillary supply of the tibialis anterior muscle in young, healthy, and moderately active men and women.

Tibialis anterior muscle biopsies from moderately active men and women (21-30 yr; n = 30) were examined to determine potential gender differences in capillarization. The fiber type proportions [type I (T1) approximately 73%] were unaffected by gender. The men (M) had significantly (P < 0.001) larger fibers than the women (W), with a greater gender effect for type II (T2) fibers (P < 0.001). The M and W had similar capillary densities (CD approximately 390 capillaries/mm2), but the capillaries-to-fiber ratio (C/F) was higher in the M (M = 2.20 +/- 0.35, W = 1.66 +/- 0.32; P < 0.01). Capillary contacts (CC) were higher in T2 than T1 for the M (P < 0.01), but not W, and M had greater CC (P < 0.001). Both fiber area per capillary (FA/C) and fiber perimeter per capillary (FP/C) indicated that T1 fibers had greater capillarization than T2 fibers (P < 0.001). There were no gender differences in T1 FA/C and T2 FA/C or T1 FP/C, but a gender difference existed for T2 FP/C (M = 60.5 +/- 10.9, W = 70.6 +/- 13.4; P < 0.01). The gender difference for C/F could be explained by fiber size; however, the physiological implications of the difference in T2 FP/C remains to be determined. In conclusion, despite gender differences for fiber size, overall, capillarization was similar between the men and women.

Distribution of different fibre types in human skeletal muscles. Fibre type arrangement in m. vastus lateralis from three groups of healthy men between 15 and 83 years.

The effects of age on the fibre type arrangement in the human muscle m. vastus lateralis were studied. There were 10, 6 and 8 healthy men in the three age-groups with means 24, 52 and 77 years, respectively. For each fascicle considered, the numbers of type 1 (ST) and type 2 (FT) fibres on the boundary and internally, and the numbers of enclosed fibres of either type, were counted. The randomness of the fibre type arrangement was considered in terms of the numbers of enclosed fibres and assessed by a Monte Carlo significance test. Fibre type grouping was shown to increase with increasing age. The proportion of type 2 fibres on the boundary of a fascicle was consistently greater than internally, but the difference was less pronounced in the old group. It is argued that the process of denervation and reinnervation of individual fibres has started before the age of 50, is a major factor in a progressive reduction of fibres with increasing age and is probably caused by a continuous loss of motor neurons in the spinal cord.

Distribution of different fibre types in human skeletal muscles. A statistical and computational model for the study of fibre type grouping and early diagnosis of skeletal muscle fibre denervation and reinnervation.

To define fibre type grouping in terms of random and non-random arrangements of the two fibre types, type 1 (ST) and type 2 (FT), we adopted the measure of counting the number of "enclosed fibres". The statistical properties of the number of enclosed fibres, and the number and size of groups of enclosed fibres were studied in computer-simulated muscle cross-sections, using a model based upon hexagonal-shaped fibres. The effects on the results of differences in the sizes of the muscle fibres were considered. The applicability of the model, and the derived results and methods of analysis were tested on 10 samples from a cross-section of a whole human muscle. The results show that the model can be applied to various shapes and sizes of muscle samples and various sizes of muscle fibres. The number of enclosed fibres within a muscle sample is the best of the three measures of non-randomness considered. A test is also described for assessing whether or not the observed number of enclosed fibres is random at a given significance level.

Distribution of different fibre types in human skeletal muscles. A statistical and computational study of the fibre type arrangement in m. vastus lateralis of young, healthy males.

To test whether the arrangement of fibre types in the human muscle (m. vastus lateralis) from clinically healthy and young males can be regarded as random, fascicles at different parts of the muscle and with different fibre type proportions were studied. The randomness of the arrangement of fibre types was assessed by the number of enclosed fibres in a fascicle and, on the basis of a model, tested by simulating muscle cross-sections using a microcomputer. The fibre type proportion was found to vary within a fascicle, so the original model for the test of randomness was modified to allow for different fibre type proportions on the border of the fascicle and internally. The effect of different sizes of the fibre types was also considered. The various aspects considered had only a marginal effect on the original model. For this muscle (m. vastus lateralis) the arrangement of fibre types was therefore considered random. Thus, a sample from this muscle, taken from individuals of the same sex and age group, can be tested for non-randomness, as an indication of a successive denervation and reinnervation process.

What is the cause of the ageing atrophy? Total number, size and proportion of different fiber types studied in whole vastus lateralis muscle from 15- to 83-year-old men.

In order to study the effects of increasing age on the human skeletal muscle, cross-sections (15 micron) of autopsied whole vastus lateralis muscle from 43 previously physically healthy men between 15 and 83 years of age were prepared and examined. The data obtained on muscle area, total number, size, proportion and distribution of type 1 (slow-twitch) and type 2 (fast-twitch) fibers were analysed using multivariate regression. The results show that the ageing atrophy of this muscle begins around 25 years of age and thereafter accelerates. This is caused mainly by a loss of fibers, with no predominant effect on any fiber type, and to a lesser extent by a reduction in fiber size, mostly of type 2 fibers. The results also suggest the occurrence of several other age-related adaptive mechanisms which could influence fiber sizes and fiber number, as well as enzyme histochemical fiber characteristics.

Ankle dorsiflexor muscle performance in healthy young men and women: reliability of eccentric peak torque and work measurements.

The aims of this study were: (i) to assess the test-retest intrarater reliability of eccentric ankle dorsiflexor muscle performance in young healthy men and women using the Biodex dynamometer; and (ii) to examine different statistical indices for the interpretation of reliability. Thirty men and women (age 22.5 +/- 2.5 years, mean +/- S.D.) performed three maximal eccentric contractions at 30 degrees/second and 90 degrees/second, with 7-10 days between test sessions. Reliability was evaluated with three intraclass correlation coefficients (ICC1,1, ICC2,1 and ICC3,1), and was excellent for peak torque (ICC 0.90-0.96) and good to excellent for work (ICC 0.69-0.83), with no discernible differences among the three ICCs. Method errors, assessed by the standard error of the measurement (S.E.M.) and S.E.M.%, were low. The Bland & Altman graphs and analyses indicated no significant systematic bias in the data. In conclusion, measurements of eccentric ankle dorsiflexor muscle performance in young healthy individuals using the Biodex are highly reliable.