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  • 801.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Forsman, Mikael
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Richter, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Effects of visually demanding near work on trapezius muscle activity2013In: Journal of Electromyography & Kinesiology, ISSN 1050-6411, E-ISSN 1873-5711, Vol. 23, no 5, p. 1190-1198Article in journal (Refereed)
    Abstract [en]

    Poor visual ergonomics is associated with visual and neck/shoulder discomfort, but the relation between visual demands and neck/shoulder muscle activity is unclear. The aims of this study were to investigate whether trapezius muscle activity was affected by: (i) eye-lens accommodation; (ii) incongruence between accommodation and convergence; and (iii) presence of neck/shoulder discomfort. Sixty-six participants (33 controls and 33 with neck pain) performed visually demanding near work under four different trial-lens conditions. Results showed that eye-lens accommodation per se did not affect trapezius muscle activity significantly. However, when incongruence between accommodation and convergence was present, a significant positive relationship between eye-lens accommodation and trapezius muscle activity was found. There were no significant group-differences. It was concluded that incongruence between accommodation and convergence is an important factor in the relation between visually demanding near work and trapezius muscle activity. The relatively low demands on accommodation and convergence in the present study imply that visually demanding near work may contribute to increased muscle activity, and over time to the development of near work related neck/shoulder discomfort.

  • 802.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Forsman, Mikael
    Karolinska Institutet.
    Richter, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, CBF. University of Gävle, Centre for Musculoskeletal Research.
    Undermålig synergonomi kan påverka muskelaktivitet och nacksmärta2011Conference paper (Refereed)
    Abstract [sv]

    Bakgrund och syfte:Det är väl dokumenterat att kroppen kompenserar undermåliga synergonomiska förhållanden med ogynnsamma arbetsställningar. Det är däremot inte klarlagt om ökad belastning av ögats muskler påverkar muskelaktivitet och smärta i nackens muskulatur. Syftet med studien var att experimentellt fastställa om ökad belastning på ögats fokuseringsmuskler vid simulerat bildskärmsarbete ger ökad aktivitet i m. trapezius och ökad upplevd nacksmärta.Metoder:Sextiosex forskningspersoner (20-47 år, 54 kvinnor, 12 män) utförde en synuppgift under tre olika randomiserade synförhållanden (binokulärt -3.5D, monokulärt -3.5D och ±0D). Uppgiften var att fokusera blicken på ett mönster på en bildskärm, placerad på 1.5 m avstånd, under 7 minuter. Förhållanden med -3.5D gjorde mönstret oskarpt och personen instruerades att viljemässigt fokusera bort oskärpan. Belastning på ögats fokuseringsmuskel mättes indirekt med en kamera (Plusoptix, Nürnberg, Tyskland). Muskelaktivitet i m. trapezius mättes med EMG. Före och efter experimentet skattade personen sin upplevda nacksmärta med Borgs CR10-skala. Under experimentet satt försökspersonen lätt tillbakalutad i en kontorsstol med nackstöd. Personerna instruerades att sitta bekvämt och avslappnat och att upprätthålla kontakt med nackstödet.Resultat:Resultatet visade att personer med en högre grad av fokusering i binokulärt förhållande (-3.5D), hade högre amplitud EMG i m. trapezius. De två monokulära förhållandena visade inget samband mellan grad av fokuserig och EMG amplitud. Detta tyder på ett positivt samband mellan ögats fokusering (ackommodation och konvergens) och aktivering i trapezius muskulaturen. Resultatet visar också att personer skattar högre nacksmärta efter experimentet jämfört med före. Konklusion:Vid simulerat bildskärmsarbete med undermåliga synförhållanden, kan förhöjd aktivitet i m. trapezius och ökad upplevd nacksmärta uppkomma efter kort tid, även om arbetsställningen är god.

  • 803.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Uppsala universitet, Arbets- och miljömedicin.
    Forsman, Mikael
    Institutet för miljömedicin, Karolinska Institutet, Stockholm, Sverige.
    Richter, Hans O.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Neck/shoulder discomfort due to visually demanding near work is influenced by previous neck pain, task duration, astigmatism, eye discomfort and accommodation2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 8, article id e0182439Article in journal (Refereed)
    Abstract [en]

    Visually demanding near work can cause eye discomfort, and eye and neck/shoulder discomfort during, e.g., computer work are associated. Here, to investigate direct effects of experimental near work on eye and neck/shoulder discomfort, 33 individuals with chronic neck pain and 33 healthy control subjects performed four visual tasks, rating eye and neck/shoulder discomfort at baseline and after each task. The cumulative performance time (reflected in the temporal order of the tasks), astigmatism, concurrent eye discomfort, and extent of accommodation all aggravated neck/shoulder discomfort. There was an interaction effect between the temporal order and eye discomfort: participants with a greater mean increase in eye discomfort also developed more neck/shoulder discomfort with time. Since moderate musculoskeletal symptoms are a risk factor for more severe symptoms, it is important to ensure a good visual environment in occupations involving visually demanding near work.

  • 804.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Lindberg, Per
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Nylén, Per
    The Swedish Work Environment Authority, and The Royal Institute of Technology.
    Hemphälä, Hillevi
    Lund University.
    Intra-rater reliability of the Visual Ergonomics Risk Assessment Method (VERAM)2018Conference paper (Refereed)
    Abstract [en]

    Introduction: Visually demanding near work can cause eye discomfort, and eye and neck/shoulder discomfort during, e.g., computer work are associated. Apart from visual demands and dryness a number of environmental factors including design of the work station, lighting, glare, and the quality of the computer screen might exert an impact on eye-related symptoms. To date, there is a lack of valid and reliable instruments assessing factors associated with eye- or visual symptoms. Therefore, a new method to assess visual ergonomics at workplaces was developed in Sweden between 2014 and 2016, the Visual Ergonomics Risk Assessment Method - VERAM. A first version of the method was drafted by the researchers mainly from existing checklists and instruments, and tested in the field by trained visual ergonomists. The method was then revised and used in the field to collect data for validity and reliability analyses. The final version of VERAM includes both a questionnaire for the employee, and an expert evaluation of the employee’s workplace. The questionnaire consists of subjective ratings in six domains: eye discomfort (frequency and intensity), musculoskeletal discomfort (frequency and intensity), ratings of visual symptoms (e.g. blurred and double vision) and ratings of the visual environment (e.g. illumination levels, glare and reflexes from a work object or a computer screen). The expert evaluation consists of both objective measurements and subjective assessments resulting in an overall expert risk assessment (no risk, low risk or high risk) of eight factors: daylight, lighting, illuminance, glare, flicker, work space, work object and work posture.

    Aim: At the IEA conference 2018 the new VERAM method will be presented together with results from intra-rater reliability analyses.

    Results: Intra-rater reliability was evaluated with a re-test interval of minimum two and maximum three weeks. 99 employees were included in the analyses and 32 visual ergonomists performed the corresponding expert evaluations. The Intraclass Correlations (ICC) were between 0.70 and 0.87 for the six subjective domains, and there were no significant systematic differences between the first and second rating for any of the subjective domains (rmANOVA, p > 0.05, α = 0.008). For the eight environmental factors the expert estimated the risk equally during the first and the second assessment in 69-92% of the cases, and, as seen for the subjective domains, there were no significant systematic differences for any of the eight factors (Wilcoxon sign rank test, p > 0.014, α = 0.006). To control for multiple comparisons the Bonferroni method was used.

    Conclusion: The Visual Ergonomics Risk Assessment Method – VERAM showed good intra-rater reliability, both for the subjective questionnaire for the employee, and for the expert evaluation of the employee’s workplace when performed by a trained visual ergonomist.

  • 805.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Heiden, Marina
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Lindberg, Per
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Nylén, Per
    Swedish Work Environment Authority, Stockholm, Sweden.
    Hemphälä, Hillevi
    Division of Ergonomics and Aerosol Technology, Design Sciences, Lund University, Lund, Sweden.
    Reliability of a new risk assessment method for visual ergonomics2019In: International Journal of Industrial Ergonomics, ISSN 0169-8141, E-ISSN 1872-8219, Vol. 72, p. 71-79Article in journal (Refereed)
    Abstract [en]

    Introduction

    The Visual Ergonomics Risk Assessment Method (VERAM) is a newly developed and validated method to assess visual ergonomics at workplaces. VERAM consists of a questionnaire and an objective evaluation.

    Objective

    To evaluate reliability of VERAM by assessing test-retest reliability of the questionnaire, and intra- and inter-rater reliability of the objective evaluation.

    Methods

    Forty-eight trained evaluators used VERAM to evaluate visual ergonomics at 174 workstations. The time interval for test-retest and intra-rater evaluations was 2–3 weeks, and the time interval for inter-rater evaluations was 0–2 days. Test-retest reliability was assessed by intraclass correlation (ICC), the standard error of measurement (SEM) and the smallest detectable change (SDC). Intra- and inter-rater reliability were assessed with weighted kappa coefficients and absolute agreement. Systematic changes were analysed with repeated measures analyses of variance and Wilcoxon sign rank test.

    Results

    The ICC of the questionnaire indices ranged from 0.69 to 0.87, while SEM ranged from 7.21 to 10.19 on a scale from 1 to 100, and SDC from 14.42 to 20.37. Intra-rater reliability of objective evaluations ranged from 0.57 to 0.85 (kappa coefficients) and the agreement from 69 to 91%. Inter-rater reliability of objective evaluations ranged from 0.37 to 0.72 (kappa coefficients) and the agreement from 52 to 87%.

    Conclusion

    VERAM is a reliable instrument for assessing risks in visual work environments. However, the reliability might increase further by improving the quality of training for evaluators. Complementary evaluations of VERAM's sensitivity to changes in the visual environment are needed.

    Relevance to industry

    It is advantageous to set up a work environment for maximal visual comfort to avoid negative effects on work postures and movements and thus prevent visual- and musculoskeletal symptoms. This method, VERAM, satisfies the need of a valid and reliable tool for determining risks associated with the visual work environment.

  • 806.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Department of Medical Sciences, Section of Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden..
    Hemphälä, Hillevi
    Ergonomics, Design Sciences, Lund University, Lund, Sweden.
    Nylén, Per
    The Swedish Work Environment Authority, and The Royal Institute of Technology.
    Lighting, visual ergonomics and health implications : A workshop2014Conference paper (Refereed)
    Abstract [en]

    Aim of the workshop:

    Deficient visual ergonomics is a problem across many occupations. Poor viewingand lighting conditions is associated with both visual and neck/shoulder discomfort,and can also impact productivity. According to the provision from the Swedish WorkEnvironment Authority on prevention of musculoskeletal disorders (AFS 2012:02), riskassessment of the visual conditions are mandatory. The aim of this workshop is toincrease knowledge about visual ergonomics among practitioners working with riskassessment, and to allow participants hands-on practice in assessing the visual environment.

    Format of the workshop:

    The first part of the workshop will involve a brief presentation of the subject visualergonomics and its implications on health and performance. The impact of progressiveglasses, too small or blurred font letters, or blurred vision on posture at e.g. computerwork will be demonstrated together with advice how to proceed to improve the conditions.The second part of the workshop will allow participants some hands-on practicein for example; how to measure light (luminance and illuminance); how different lightconditions impact pupil size and visual comfort; how to measure and quantify amountof flicker, light modulation and colour rendering in different light sources. Several usefulmobile phone applications concerning light and vision will be demonstrated.

  • 807.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Hemphälä, Hillevi
    Lund University.
    Nylén, Per
    The Swedish Work Environment Authority, and The Royal Institute of Technology.
    Workshop in visual ergonomics2013Conference paper (Refereed)
    Abstract [en]

    Increased use of computers is common across many work sectors. Prolonged near work at a computer screen is associated with both visual discomfort and neck/shoulder discomfort and pain. Inadequate visual ergonomics at a computer workstation can also influence both visual and neck/shoulder discomfort. The new provision from the Swedish Work Environment Authority on prevention of musculoskeletal disorders includes risk assessment of occupational visual conditions. These assessments require practitioners to have knowledge of the topic, as well as experience with practical assessment tools.

    The first part of the workshop proposed here will involve a presentation of the theories underlying visual ergonomic practices and a discussion of the most important factors to assess at a computer workstation. These factors include contrast, font size, resolution, glare, reflexion, non-visual flicker, and edge sharpness. The second part of the workshop, will allow participants hands-on practice in measuring and evaluating visual ergonomics at a computer workstation.

  • 808.
    Zetterberg, Camilla
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Department of Medical Sciences, Section of Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden..
    Richter, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Forsman, Mikael
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research. Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Temporal co-variation between eye lens accommodation and trapezius muscle activity during a dynamic near-far visual task2015In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 5, article id e0126578Article in journal (Refereed)
    Abstract [en]

    Near work is associated with increased activity in the neck and shoulder muscles, but the underlying mechanism is still unknown. This study was designed to determine whether a dynamic change in focus, alternating between a nearby and a more distant visual target, produces a direct parallel change in trapezius muscle activity. Fourteen healthy controls and 12 patients with a history of visual and neck/shoulder symptoms performed a Near-Far visual task under three different viewing conditions; one neutral condition with no trial lenses, one condition with negative trial lenses to create increased accommodation, and one condition with positive trial lenses to create decreased accommodation. Eye lens accommodation and trapezius muscle activity were continuously recorded. The trapezius muscle activity was significantly higher during Near than during Far focusing periods for both groups within the neutral viewing condition, and there was a significant co-variation in time between accommodation and trapezius muscle activity within the neutral and positive viewing conditions for the control group. In conclusion, these results reveal a connection between Near focusing and increased muscle activity during dynamic changes in focus between a nearby and a far target. A direct link, from the accommodation/vergence system to the trapezius muscles cannot be ruled out, but the connection may also be explained by an increased need for eye-neck (head) stabilization when focusing on a nearby target as compared to a more distant target.

  • 809.
    Zetterlund, Christina
    et al.
    Centre for Rehabilitation Research, Örebro University Hospital.
    Lundqvist, Lars-Olof
    Centre for Rehabilitation Research, Örebro University Hospital.
    Richter, Hans
    University of Gävle, Centre for Musculoskeletal Research. University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science.
    The relationship between low vision and musculoskeletal complaints: A case control study between age-related macular degeneration patients and age-matched controls with normal vision2009In: Journal of Optometry, ISSN 1888-4296, Vol. 2, no 3, p. 127-133Article in journal (Refereed)
    Abstract [en]

    Introduction: Age-related Macular Degeneration (AMD) patients often describe complaints from neck and scapula area muscles and a decreased postural control. In clinical assessment, these complaints are considered to be due to old age. Purpose: This study focuses on low vision patients with AMD, compared to age matched controls, without eye disease, in order to evaluate if a linkage between self-rated visual and muskuloskeletal complaints are more prominent when low vision is present. Methods: In a cross-sectional study, 24 AMD patients, aged 65-85 years, were compared to 24 controls of similar ages without visual problems. Visual acuity, the need for magnification plus other optical and visual data, were obtained. Visual, muskuloskeletal and balance/propriopceptive complaints were collected with a self-rating questionnaire. The Visual Functioning Questionnaire -Near Activities Subscale (VFQ-NAS) was used to evaluate visual function and related complaints. Results: The correlation coefficient between visual and musculoskeletal complaints yielded significant values when computed separately within each group as well as when calculated on the entire material (AMD ρ = 0.60, P = 0.002; control group ρ = 0.59, P = 0.004; both groups together ρ = 0.50 P < 0.001). Stepwise multiple regression analysis supported the hypothesized effect of vision (Visual complaints + Minimal readable typefaces) on musculoskeletal complaints, (R2 = 0.42, P < 0.05). Conclusions: The results in this study support the hypothesis of a relationship between visual and muskuloskeletal problems.

  • 810.
    Zetterlund, Christina
    et al.
    School of Health and Medicine, Örebro University, Örebro, Sweden.
    Lundqvist, Lars-Olov
    Centre for Rehabilitiation Research, Örebro County Council, Örebro, Sweden.
    Richter, Hans
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Visual, musculoskeletal and balance symptoms in individuals with visual impairment and with age-normal vision2019In: Clinical and experimental optometry, ISSN 0816-4622, E-ISSN 1444-0938, Vol. 102, no 1, p. 63-69Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    Visual impairment is globally among the most prevalent disabilities. Research concerning the health consequences of visual deficits is challenged by confounding effects of age, because visual impairment becomes more prevalent with age. This study investigates the influence of visual deficits on visual, musculoskeletal and balance symptoms in adults with and without visual impairment, while controlling for age effects.

    METHODS:

    Thirty-nine patients with visual impairment, aged 18-72 years, were compared to 37 age-matched controls with normal vision, allocated to two age groups: < 45 and ≥ 45 years. Self-reported symptoms were measured using the Visual, Musculoskeletal and Balance Symptoms Questionnaire and compared with demographic and optometric variables.

    RESULTS:

    In total, patients with visual impairment reported more symptoms than age-matched normally sighted controls. Younger adults in the control group were almost free from symptoms, whereas younger adults with visual impairment reported levels of symptoms equal to older adults with visual impairment. Multiple logistic regression modelling identified use of eyeglasses, magnifying aids and presence of anisometropia to be the most influential risk factors for reporting visual, musculoskeletal and balance symptoms, with accentuated influence on balance symptoms.

    CONCLUSIONS:

    People with visual impairments and people with age-related normal visual deficits are both predisposed to report visual, musculoskeletal and balance symptoms relative to people without visual defects or need for eye-wear correction. Age-related variations in symptoms were observed in the control groups but not in the visual impairment groups, with younger visual impairment patients reporting as many symptoms as older visual impairment patients. These findings indicate a need for a wider interdisciplinary perspective on eye care concerning people with visual impairment and people with need for habitual daily use of eye wear correction.

  • 811.
    Zetterlund, Christina
    et al.
    The Low Vision Centre, Region Örebro County, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Richter, Hans O.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Occupational health science. University of Gävle, Centre for Musculoskeletal Research.
    Lundqvist, Lars-Olov
    University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Visual, Musculoskeletal, and Balance Complaints in AMD: A Follow-Up Study2016In: Journal of Ophthalmology, ISSN 2090-004X, E-ISSN 2090-0058, Vol. 2016, article id 2707102Article in journal (Refereed)
    Abstract [en]

    Purpose. To investigate whether patients with age-related macular degeneration (AMD) run a potentially higher risk of developing visual, musculoskeletal, and balance complaints than age-matched controls with normal vision. Methods. Visual assessments, self-rated visual function, self-rated visual, musculoskeletal, and balance complaints, and perceived general health were obtained in 37 AMD patients and 18 controls, at baseline and after an average of 3.8 years later. Results. At follow-up both groups reported decreased visual acuity (VA) and visual function, but only AMD patients reported significantly increased visual, musculoskeletal, and balance complaints. Decreased VA, need for larger font size when reading, need for larger magnification, and decreased self-rated visual function were identified as risk markers for increased complaints in AMD patients. These complaints were also identified as risk markers for decreased health. For controls, decreased VA and self-reported visual function were associated with increased visual and balance complaints. Conclusions. Visual deterioration was a risk marker for increased visual, musculoskeletal, balance, and health complaints in AMD patients. Specifically, magnifying visual aids, such as CCTV, were a risk marker for increased complaints in AMD patients. This calls for early and coordinated actions to treat and prevent visual, musculoskeletal, balance, and health complaints in AMD patients.

  • 812.
    Åsell, Malin
    et al.
    University of Gävle, Centre for Musculoskeletal Research. Svenska Rygginstitutet AB, Sundsvall, Sweden; Department of Odontology, Clinical Oral Physiology, Umeå University, Umeå, Sweden.
    Sjölander, Per
    University of Gävle, Centre for Musculoskeletal Research. Southern Lapland Research Department, Vilhelmina, Sweden.
    Kerschbaumer, Helmut
    Svenska Rygginstitutet AB, Sundsvall, Sweden.
    Djupsjöbacka, Mats
    University of Gävle, Centre for Musculoskeletal Research.
    Are lumbar repositioning errors larger among patients with chronic low back pain compared with asymptomatic subjects?2006In: Archives of Physical Medicine and Rehabilitation, ISSN 0003-9993, E-ISSN 1532-821X, Vol. 87, no 9, p. 1170-1176Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To resolve the debate over whether lumbar repositioning acuity is reduced in patients with chronic low back pain (CLBP) by using a study design and methodology to minimize the effects of potential confounders. DESIGN: A single-blinded, controlled, multigroup comparative study.

    SETTING: Vocational rehabilitation center.

    PARTICIPANTS: Ninety-two patients with CLBP, divided into subgroups based on severity of symptoms and diagnostic characteristics. An age- and sex-matched group (n=31) of healthy subjects were the control. I

    NTERVENTIONS: Not applicable.

    MAIN OUTCOME MEASURES: We measured repositioning errors (variable, constant) at 3 positions of the lumbar spine. Subjects were guided to a sitting target posture and asked to perform lumbar flexion before reproducing the target posture. Self-assessed pain, self-efficacy, and functional ability were addressed through questionnaires.

    RESULTS: There were no differences in repositioning errors between the patients with CLBP or the subgroups of patients and the control group. We found only weak correlations between the repositioning errors and the self-reported data on functional disability, self-efficacy, and pain.

    CONCLUSIONS: We suggest that sensorimotor dysfunctions in CLBP should be evaluated with methods other than repositioning tests in order to generate data relevant to the development of rational diagnostic methods and rehabilitation programs.

  • 813.
    Öhberg, Fredrik
    University of Gävle, Centre for Musculoskeletal Research.
    Biomechanical methods and error analysis related to chronic musculoskeletal pain2009Doctoral thesis, monograph (Other academic)
    Abstract [en]

    Background Spinal pain is one of humanity’s most frequent complaints with high costs for the individual and society, and is commonly related to spinal disorders. There are many origins behind these disorders e.g., trauma, disc hernia or of other organic origins. However, for many of the disorders, the origin is not known. Thus, more knowledge is needed about how pain affects the neck and neural function in pain affected regions. The purpose of this dissertation was to improve the medical examination of patients suffering from chronic whiplash-associated disorders or other pain related neck-disorders.

    Methods A new assessment tool for objective movement analysis was developed. In addition, basic aspects of proprioceptive information transmission, which can be of relevance for muscular tension and pain, are investigated by studying the coding of populations of different types of sensory afferents by using a new spike sorting method. Both experiments in animal models and humans were studied to accomplish the goals of this dissertation. Four cats where were studied in acute animal experiments. Mixed ensembles of afferents were recorded from L7-S1 dorsal root filaments when mechanical stimulating the innervated muscle. A real-time spike sorting method was developed to sort units in a multi-unit recording. The quantification of population coding was performed using a method based on principal component analysis. In the human studies, 3D neck movement data were collected from 59 subjects with whiplash-associated disorders (WAD) and 56 control subjects. Neck movement patterns were identified by processing movement data into parameters describing the rotation of the head for each subject. Classification of neck movement patterns was performed using a neural network using processed collected data as input. Finally, the effect of marker position error on the estimated rotation of the head was evaluated by computer simulations.

    Results Animal experiments showed that mixed ensembles of different types of afferents discriminated better between different muscle stimuli than ensembles of single types of these afferents. All kinds of ensembles showed an increase in discriminative ability with increased ensemble size. It is hypothesized that the main reason for the greater discriminative ability might be the variation in sensitivity tuning among the individual afferents of the mixed ensemble will be larger than that for ensembles of only one type of afferent. In the human studies, the neural networks had a predictivity of 0.89, a sensitivity of 0.90 and a specificity of 0.88 when discriminating between control and WAD subjects. Also, a systematic error along the radial axis of the rigid body added to a single marker had no affect on the estimated rotation of the head.

    Conclusion The developed spike sorting method, using neural networks, was suitable for sorting a multiunit recording into single units when performing neurophysiological experiments. Also, it was shown that neck movement analysis combined with a neural network could build the basis of a decision support system for classifying suspected WAD or other pain related neck-disorders.

  • 814.
    Österlund, Catharina
    et al.
    University of Umeå, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå, Sweden.
    Nilsson, Evelina
    University of Umeå, Faculty of Medicine, Department of Odontology, Clinical Oral Physiology, Umeå, Sweden.
    Hellström, Fredrik
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational Health Science and Psychology, Occupational Health Science. University of Gävle, Centre for Musculoskeletal Research.
    Häger, Charlotte K.
    University of Umeå, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Umeå, Sweden.
    Häggman-Henrikson, Birgitta
    University of Malmö, Faculty of Odontology, Orofacial Pain and Jaw Function, Malmö, Sweden.; Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden.
    Jaw-neck movement integration in 6-year old children differs from that of adults2020In: Journal of Oral Rehabilitation, ISSN 0305-182X, E-ISSN 1365-2842, Vol. 47, no 1, p. 27-35Article in journal (Refereed)
    Abstract [en]

    Background: A functional integration between the jaw and neck regions during purposive jaw movements is well described in adults, but there is a lack of knowledge of such integration during jaw function in children.; Objectives: To determine the movement integration between the jaw and neck during jaw motor tasks in 6-year-olds, whether there is a difference between children and adults.; Methods: Jaw and neck movements were recorded with an optoelectronic 3D system in 25 healthy 6-year-olds (12 girls, 13 boys) and 24 healthy adults (12 women, 12 men) during paced jaw opening-closing and self-paced gum chewing. Jaw and neck movement amplitudes, intra-individual variation in movement amplitude, ratio between neck-jaw movement amplitudes, and movement cycle time were analysed. Differences between children and adults were evaluated with Mann-Whitney U test for independent samples.; Results: Compared to adults, 6-year old children showed larger neck movement amplitudes (P=0.008) during chewing, higher intra-individual variability in amplitudes of jaw (P=0.008) and neck (P=0.001) movements, higher ratio between neck-jaw movement amplitudes for jaw opening-closing (P=0.026) and chewing (P=0.003), and longer jaw movement cycle time (P≤0.0001) during the jaw opening-closing task.; Conclusion: Despite integrated jaw-neck movements in 6-year old children, the movement pattern differs from that of adults and may be interpreted as an immature programming of jaw-neck motor behavior. The well-integrated movements observed in adults most likely develop over years, perhaps into adolescence, and needs further research including well controlled longitudinal studies to map this development in order to provide appropriate age-related clinical treatment for functional disorders. This article is protected by copyright. All rights reserved.; This article is protected by copyright. All rights reserved.

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