Relationships between postural orientation and self reported function, hop performance and muscle power in subjects with anterior cruciate ligament injury.

ABSTRACT: BACKGROUND: Injury to the anterior cruciate ligament (ACL) is associated not only with knee instability and impaired neuromuscular control, but also with altered postural orientation manifested as observable "substitution patterns". However, tests currently used to evaluate knee function in subjects with ACL injury are not designed to assess postural orientation. Therefore, we are in the process of developing an observational test set that measures postural orientation in terms of the ability to stabilize body segments in relation to each other and to the environment. The aim of the present study was to characterise correlations between this novel test set, called the Test for Substitution Patterns (TSP) and commonly used tests of knee function. METHODS: In a blinded set-up, 53 subjects (mean age 30 years, range 20-39, with 2-5 years since ACL injury) were assessed using the TSP, the Knee Injury and Osteoarthritis Outcome Score subscale sport/recreation (KOOS sport/rec), 3 hop tests and 3 muscle power tests. Correlations between the scores of the TSP and the other tests were determined. RESULTS: Moderate correlations were found between TSP scores and KOOS sport/rec (rs = -0.43; p = 0.001) and between TSP scores and hop test results (rs = -0.40 to -0.46; p </= 0.003), indicating that altered postural orientation was associated with worse self-reported KOOS sport/rec function and worse hop performance. No significant correlations were found between TSP scores and muscle power results. Subjects had higher TSP scores on their injured side than on their uninjured side (median 4 and 1 points; interquartile range 2-6 and 0-1.5, respectively; p < 0.0001). CONCLUSIONS: We conclude that the Test for Substitution Patterns is of relevance to the patient and measures a specific aspect of neuromuscular control not quantified by the other tests investigated. We suggest that the TSP may be a valuable complement in the assessment of neuromuscular control in the rehabilitation of subjects with ACL injury

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Altered movement patterns and deviating muscular activity in individuals with anterior cruciate ligament injury

The purpose of this thesis was to increase the understanding of altered movement patterns in individuals with anterior cruciate ligament (ACL) injury in order to improve ACL rehabilitation, and to develop an observational instrument termed Test for Substitution Patterns (TSP) for standardized, quantifiable scoring of altered movement patterns in legs and trunk. In all, 142 participants, 93 with ACL-rupture (37 women) and 49 uninjured participants were investigated. The TSP was evaluated in a blinded setup and correlated to self-reported outcome instruments, hop tests, and strength tests. Surface electromyography was synchronised with electrogoniometers and video-recordings and recorded bilaterally in hip, thigh, and shank muscles while the individuals performed TSP movements and a transfer movement from double- to single-leg stances with their eyes closed. Altered movement patterns were more frequent (higher TSP score) on the injured side compared to uninjured side and compared to uninjured participants. Inter-rater and intra-rater reproducibility of the TSP were good at group level, and TSP scores correlated to self-reported outcome instruments and hop tests, but not to muscle strength. Lower muscular activity in specific muscles and changes in antagonistic activity in quadriceps/hamstrings within injured side were observed during single- and double-leg squats (SLS, DLS, included in the TSP). On injured side, the activity at movement onset in shank muscles during the transfer movement and muscle peak amplitude in antigravity muscles deviated from uninjured side. Specific altered movement patterns correlated with specific deviations in muscular activity during SLS, and low muscle activity in specific muscles at movement onset during the transfer movement correlated to high TSP score. Based on these findings, it is concluded that altered movement patterns are more frequent in individuals with ACL injury and can be quantitatively and reproducibly scored with the TSP. Deviations found in muscle activity patterns indicate altered strategies in sensorimotor control that might contribute to altered movement patterns. It is recommended that altered movement patterns and associated deviating muscular activity be considered during ACL rehabilitation

Läs- och skrivundervisning i åldersblandade och åldershomogena klasser i de tidigare åren

Arbetet syftar till att göra en jämförande undersökning av läs- och skrivundervisningen i åldersblandade och åldershomogena klasser i de tidigare åren. Jag har genomfört en kvalitativ undersökning av två skolor på olika orter i södra Sverige, där ena skolan arbetar åldersblandat och den andra åldershomogent. Jag har genomfört klassrumsobservationer på sammanlagt ca 12 timmar. Jag har också intervjuat respektive klasslärare. Resultaten tyder på att det finns några likheter, men främst skillnader i hur läs- och skrivundervisningen ser ut. I den åldersblandade klassen arbetade man mycket individuellt och efter arbetsscheman. Man använde främst bokstavsmetoden som läsinlärningsmetod. I den åldershomogena klassen utgick arbetet ofta från en lärarledd genomgång där man enligt LTG-metoden diskuterade fram arbetsmaterialet tillsammans med eleverna. Lärarnas erfarenheter kring att arbeta åldersblandat visade sig vara positiva överlag.Slutsatsen är att det kan finnas skillnader mellan läs- och skrivundervisningen i åldersblandade och åldershomogena klasser och att dessa skillnader kan medföra vissa pedagogiska konsekvenser. Åldersblandningen i sig verkar inte påverka i lika stor utsträckning som sättet att undervisa och medvetenheten om vilka pedagogiska vinster och förluster det ger

Quantitative survey of psychology students' psychological health at Linnaeus University : An examination of the correlations betweenanxiety, perfectionism and educational elements

Objective: To broaden the understanding of Swedish psychology student’s psychological health. Issue: Is there psychological illness in terms of self rated anxiety, among the psychology student at Linnaeus University? Are there correlations between self rated anxiety, perfectionistic personality traits and/or educational elements?  Method: A cross-sectional study of  psychology students (N = 65). The participants were recruited via the social media Facebook, and answered an anonymous web survey consisting of Depression Anxiety Stress Scales (DASS-21) and Clinical Perfectionism Questionnaire (CPQ). The participants were divided into two groups based on whether they had clinical (N=19) or theoretical (N=46) elements in their current education. Correlation analysis and ancova were executed in order to answer the issue. Results: Anxiety and perfectionism correlated positively (p=.000). Anxiety correlated positively with theoretical elements (p=.000) but not with clinical educational elements. Perfectionism and anxiety correlated positively during theoretical educational elements p=.007). Conclusion: The results indicate that higher perfectionism can correlate with higher levels of anxiety. It indicates that the perfectionism might have clinical properties. The students' results in relation to educational elements indicate that the participants had rated lower levels of anxiety during the clinical elements of the education. The study was limited in that it did not look into gender identification or underlying causes of non-response, and a small sample with large non-response bias (57%). The limitations mean that the results were not generalisable

Can Baseline Characteristics Predict Successful Outcomes after Individual, Physiotherapist-Led Rehabilitation in Patients with Chronic Musculoskeletal Pain?

BACKGROUND: No strong and consistent variables to predict outcome after pain rehabilitation have been reported in patients with chronic musculoskeletal pain. The aim of the present study was to clarify if baseline variables could predict successful outcome after a unique, individualized, physiotherapist-led rehabilitation of nine sessions.METHODS: In 274 individuals with severe chronic musculoskeletal pain, the risk ratio (RR) and 95% confidence intervals (CIs) were estimated for potentially predictive baseline variables on successful outcomes of pain management, overall health, and pain rating.RESULTS: Statistically significant results show that patients rating moderate or severe baseline pain were in both cases 14% less likely to improve pain management compared to patients rating mild baseline pain (RR = 0.86; 95% CI 0.77-0.97, RR = 0.86; 95% CI 0.74-1.00). Patients with the shortest pain duration were 1.61 times more likely to improve overall health (RR = 1.61; 95% CI 1.13-2.29) compared to patients reporting the longest pain duration (>5 years). Patients reporting anxiety/depression or severe pain were in both cases 1.48 times more likely to improve overall health compared to better baseline presentations (RR = 1.48; 95% CI 1.16-1.88, RR = 1.48; 95% CI 1.03-2.15). Patients with regional/generalized pain were 36% less likely to rate pain reduction (RR = 0.64; 95% CI 0.41-1.00) compared to patients rating localized baseline pain. Of 17 potentially predictive baseline variables, four reached statistical significance for at least one of the three outcomes; although none of them for all three outcomes.CONCLUSIONS: Of 17 potentially predictive baseline variables, mild pain ratings, short pain duration, and localized baseline pain were statistically significantly associated with improvements after individual, physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain. This suggests that this type of rehabilitation probably should be offered early in the pain process. Reporting anxiety/depression or severe pain at the baseline did not hinder the improvements of overall health

En Utvärdering av utbildningen Traumamedveten Omsorg : Rappport 1 och 2

In this report we investigate further adult education directed towards teachers at primary and secondary level. The further education provided teachers with knowledge and tools in regards to working with pupils who have experienced trauma.