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  • 1. C., Byrn
    et al.
    Peter, Borenstein
    Göteborgs universitet.
    L.-E., Linder
    Treatment of neck and shoulder pain in whip-lash syndrome patients with intracutaneous sterile water injections1991In: Acta Anaesthesiologica Scandinavica, Vol. 35, no 1, p. 52-53Article in journal (Refereed)
    Abstract [en]

    Ten whip-lash syndrome patients treated with intracutaneous triggerpoint injections with sterile water for pain relief were followed for 2 months. Pain intensity was evaluated with the Visual Analogue Scale (VAS). Eight patients became free from pain (VAS 0) and two patients improved to VAS 2 immediately after the treatment. Nine patients remained free from pain, three of them after one treatment, while six patients needed 2-4 treatments. One patient responded only a few hours after each of three treatments. Remarkably, with the relief of pain mobility was normalised in all patients. The method is suggested to be a first choice in the treatment of not only whip-lash patients but also for most acute and chronic musculo-skeletal triggerpoint pain syndromes.

  • 2. E., Hedberg-Borenstein
    et al.
    Peter, Borenstein
    Göteborgs universitet.
    A., Lundgren
    I., Vidal
    The importance of disconnection and diaschisis in aphasia - A case study1992In: Scandinavian Journal of Rehabilitation Medicine, Supplement, ISSN 0346-8720, no 26, p. 81-82Article in journal (Refereed)
  • 3. E., Hedberg-Borenstein
    et al.
    Peter, Borenstein
    Göteborgs universitet.
    L., Blomert
    Amsterdam-Nijmegen everyday language test - A swedish adaptation of a new test for verbal communication in aphasics1992In: Scandinavian Journal of Rehabilitation Medicine, Supplement, no 26Article in journal (Refereed)
  • 4. Iglebekk, Wenche
    et al.
    Tjell, Carsten
    Borenstein, Peter
    University of Borås, School of Health Science.
    Pain and other symptoms in patients with chronic benign paroxysmal positional vertigo (BPPV)2013In: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 4, no 4, p. 233-240Article in journal (Refereed)
    Abstract [en]

    Background and aim A diagnosis of chronic benign paroxysmal positional vertigo (BPPV) is based on brief attacks of rotatory vertigo and concomitant nystagmus elicited by rapid changes in head position relative to gravity. However, the clinical course of BPPV may vary considerably from a self-limiting to a persisting and/or recurrent disabling problem. The authors’ experience is that the most common complaints of patients with chronic BPPV are nautical vertigo or dizziness with other symptoms including neck pain, headache, widespread musculoskeletal pain, fatigue, and visual disturbances. Trauma is believed to be the major cause of BPPV in individuals younger than fifty years. Chronic BPPV is associated with high morbidity. Since these patients often suffer from pain and do not have rotatory vertigo, their symptoms are often attributed to other conditions. The aim of this study was to investigate possible associations between these symptoms and chronic BPPV. Methods During 2010 a consecutive prospective cohort observational study was performed. Diagnostic criteria: (A) BPPV diagnosis confirmed by the following: (1) a specific history of vertigo/dizziness evoked by acceleration/deceleration, (2) nystagmus in the first position of otolith repositioning maneuvers, and (3) appearing and disappearing nystagmus during the repositioning maneuvers; (B) the disorder has persisted for at least six months. (C) Normal MRI of the cerebrum. Exclusion criteria: (A) Any disorder of the central nervous system (CNS), (B) migraine, (C) active Ménière's disease, and (D) severe eye disorders. Symptom questionnaire (‘yes or no’ answers during a personal interview) and Dizziness Handicap Inventory (DHI) were used. Results We included 69 patients (20 males and 49 females) with a median age of 45 years (range 21–68 years). The median duration of the disease was five years and three months. The video-oculography confirmed BPPV in more than one semicircular canal in all patients. In 15% there was a latency of more than 1 min before nystagmus occurred. The Dizziness Handicap Inventory (DHI) median score was 55.5 (score >60 indicates a risk of fall). Seventy-five percent were on 50–100% sick leave. Eighty-one percent had a history of head or neck trauma. Nineteen percent could not recall any history of trauma. In our cohort, nautical vertigo and dizziness (81%) was far more common than rotatory vertigo (20%). The majority of patients (87%) reported pain as a major symptom: neck pain (87%), headache (75%) and widespread pain (40%). Fatigue (85%), visual disturbances (84%), and decreased concentration ability (81%) were the most frequently reported symptoms. In addition, unexpected findings such as involuntary movements of the extremities, face, neck or torso were found during otolith repositioning maneuvers (12%). We describe one case, as an example, how treatment of his BPPV also resolved his chronic, severe pain condition. Conclusion This observational study demonstrates a likely connection between chronic BPPV and the following symptoms: nautical vertigo/dizziness, neck pain, headache, widespread pain, fatigue, visual disturbances, cognitive dysfunctions, nausea, and tinnitus. Implications Patients with complex pain conditions associated with nautical vertigo and dizziness should be evaluated with the Dizziness Handicap Inventory (DHI)-questionnaire which can identify treatable balance disorders in patients with chronic musculoskeletal pain.

  • 5. Lampl, Yair
    et al.
    Zivin, Justin A
    Fisher, Marc
    Lew, Robert
    Welin, Lennart
    Dahlof, Bjorn
    Borenstein, Peter
    Skene Lasarett.
    Andersson, Bjorn
    Perez, Julio
    Caparo, Cesar
    Ilic, Sanja
    Oron, Uri
    Infrared laser therapy for ischemic stroke: a new treatment strategy2007In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 38, no 6, p. 1843-9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: The NeuroThera Effectiveness and Safety Trial-1 (NEST-1) study evaluated the safety and preliminary effectiveness of the NeuroThera Laser System in the ability to improve 90-day outcomes in ischemic stroke patients treated within 24 hours from stroke onset. The NeuroThera Laser System therapeutic approach involves use of infrared laser technology and has shown significant and sustained beneficial effects in animal models of ischemic stroke.

    METHODS: This was a prospective, intention-to-treat, multicenter, international, double-blind, trial involving 120 ischemic stroke patients treated, randomized 2:1 ratio, with 79 patients in the active treatment group and 41 in the sham (placebo) control group. Only patients with baseline stroke severity measured by National Institutes of Health Stroke Scale (NIHSS) scores of 7 to 22 were included. Patients who received tissue plasminogen activator were excluded. Outcome measures were the patients' scores on the NIHSS, modified Rankin Scale (mRS), Barthel Index, and Glasgow Outcome Scale at 90 days after treatment. The primary outcome measure, prospectively identified, was successful treatment, documented by NIHSS. This was defined as a complete recovery at day 90 (NIHSS 0 to 1), or a decrease in NIHSS score of at least 9 points (day 90 versus baseline), and was tested as a binary measure (bNIH). Secondary outcome measures included mRS, Barthel Index, and Glasgow Outcome Scale. Primary statistical analyses were performed with the Cochran-Mantel-Haenszel rank test, stratified by baseline NIHSS score or by time to treatment for the bNIH and mRS. Logistic regression analyses were conducted to confirm the results.

    RESULTS: Mean time to treatment was >16 hours (median time to treatment 18 hours for active and 17 hours for control). Time to treatment ranged from 2 to 24 hours. More patients (70%) in the active treatment group had successful outcomes than did controls (51%), as measured prospectively on the bNIH (P=0.035 stratified by severity and time to treatment; P=0.048 stratified only by severity). Similarly, more patients (59%) had successful outcomes than did controls (44%) as measured at 90 days as a binary mRS score of 0 to 2 (P=0.034 stratified by severity and time to treatment; P=0.043 stratified only by severity). Also, more patients in the active treatment group had successful outcomes than controls as measured by the change in mean NIHSS score from baseline to 90 days (P=0.021 stratified by time to treatment) and the full mRS ("shift in Rankin") score (P=0.020 stratified by severity and time to treatment; P=0.026 stratified only by severity). The prevalence odds ratio for bNIH was 1.40 (95% CI, 1.01 to 1.93) and for binary mRS was 1.38 (95% CI, 1.03 to 1.83), controlling for baseline severity. Similar results held for the Barthel Index and Glasgow Outcome Scale. Mortality rates and serious adverse events (SAEs) did not differ significantly (8.9% and 25.3% for active 9.8% and 36.6% for control, respectively, for mortality and SAEs).

    CONCLUSIONS: The NEST-1 study indicates that infrared laser therapy has shown initial safety and effectiveness for the treatment of ischemic stroke in humans when initiated within 24 hours of stroke onset. A larger confirmatory trial to demonstrate safety and effectiveness is warranted.

  • 6. M., Rosenfeld
    et al.
    R., Gunnarsson
    Peter, Borenstein
    Göteborgs universitet.
    An active exercise and posture protocol reduced pain in acute whiplash injuries2001In: Evidence-Based Medicine, Vol. 6, no 3Article in journal (Refereed)
  • 7. M., Rosenfeld
    et al.
    R., Gunnarsson
    Borås primärvård.
    Peter, Borenstein
    Göteborgs universitet.
    Early intervention in whiplash-associated disorders: A comparison of two treatment protocols2000In: Spine, Vol. 25, no 14, p. 1782-1787Article in journal (Refereed)
    Abstract [en]

    Study Design. A prospective randomized trial in 97 patients with a whiplash injury caused by a motor vehicle collision. Objectives. The study evaluates early active mobilization versus a standard treatment protocol and the importance of early versus delayed onset of treatment. Summary of Background Data. There is no compelling evidence to date on the management of acute whiplash-associated disorders. The few studies describing treatment, however, provide evidence to support the recommendation that an active treatment in the acute stage is preferable to rest and a soft collar in most patients. Methods. Patients were randomized to four groups. Active versus standard treatment and early (within 96 hours) versus delayed (after 2 weeks) treatment. Measures of range of motion and pain were registered initially and at 6 months. Results. Eighty-eight patients (91%) could be followed up at 6 months. Active treatment reduced pain more than standard treatment (P < 0.001). When type and onset of treatment were analyzed, a combined effect was seen. When active treatment was provided, it was better when administered early, and if standard treatment was provided, it was better when administered late for reduction of pain (P = 0.04) and increasing cervical flexion (P = 0.01). Conclusions. In patients with whiplash-associated disorders caused by a motor vehicle collision treatment with frequently repeated active sub maximal movements combined with mechanical diagnosis and therapy is more effective in reducing pain than a standard program of initial rest, recommended use of a soft collar, and gradual self-mobilization. This therapy could be performed as home exercises initiated and supported by a physiotherapist.

  • 8. P., Wahrborg
    et al.
    Peter, Borenstein
    Göteborgs universitet.
    Family therapy in families with an aphasic member1989In: Aphasiology, Vol. 3, no 1, p. 93-98Article in journal (Refereed)
  • 9. P., Wahrborg
    et al.
    Peter, Borenstein
    Göteborgs universitet.
    The aphasic person and his/her family: What about the future?1990In: Aphasiology, Vol. 4, no 4, p. 371-378Article in journal (Refereed)
  • 10. P., Währborg
    et al.
    Peter, Borenstein
    Göteborgs universitet.
    S., Linell
    E., Hedberg-Borenstein
    M., Asking
    Ten-year follow-up of young aphasic participants in a 34-week course at a folk high school1997In: Aphasiology, Vol. 11, no 7, p. 709-715Article in journal (Refereed)
    Abstract [en]

    An altered social life, dependency, loneliness and even a progressive social and psychological deterioration have been reported in aphasic stroke victims. In an attempt to improve rehabilitation for aphasic people and their relatives we presented in 1987 the effects of a structured 1-week course located at a 'Folk High School'. As a development of this short course a 34-week educational programme for young aphasics was designed. Results from this course were presented in 1987. We now present results from a 10-year follow-up. Eight young aphasic people, less than 50 years of age, participated in the course. The participants were assessed on three occasions. Standardized neurological examination, aphasia examination, verbal performance rating, short-term memory and quality-of-life examination were performed. The participants improved in verbal performance as well as in aphasiological status from the beginning of the course to the end of the course. This improvement was diminished at follow-up 10 years later. All participants who completed the 34-week course showed an improvement in their aphasiological status immediately after the course. At follow-up 10 years later, all participants except one showed a more severe aphasia than at the end of the course. It is especially remarkable that in several cases the total percentile scores for auditory comprehension and/or repetition (of words and phrases) were lower than even at the beginning of the course. Concerning quality of life the participants reported differently. In this study we did not find that the improvement found immediately after the course in aphasic status and verbal performance was maintained after 10 years. It could be that the improvement found immediately after the course was due to an intensive use of language during the course, but also as a result of the rich social life at these schools. An improvement in aphasic status was found in one case. Most participants reported an improved quality of life after the course compared to before. Only one participant reported an overall deterioration, due to a depression, existing before the participant became aphasic. Despite the limited size of this study, and the associated uncertainty in data interpretation, we conclude that this course has had a major impact on the participants, and that they have gained a better quality of life even though the improved verbal performance and aphasic status were not maintained.

  • 11.
    Peter, Borenstein
    et al.
    Östra sjukhuset, Göteborg.
    M., Rosenfeld
    R., Gunnarsson
    Cognitive symptoms, cervical range of motion and pain as prognostic factors after whiplash trauma2010In: Acta Neurologica Scandinavica, Vol. 122, no 4, p. 278-285Article in journal (Refereed)
    Abstract [en]

    Objectives - To evaluate pain, cervical range of motion (CROM) and cognitive symptoms as predictors for poor prognosis defined as sick leave 3 years later. Material and methods - In 97 patients CROM, pain intensity and cognitive symptoms were measured immediately following trauma, at 6 months and 3 years. Patients were also asked at 3 years if they had been on sick leave the last 6 months. Results - Pain intensity and reduced CROM were not clinically useful as predictors of later sick leave. The best predictors were presence within 96 h after injury of the two cognitive symptoms 'being easily distracted' (odds ratio 8.7-50) and 'easily irritated' (odds ratio 5.3-31). Conclusions - Initial pain and reduced CROM may be related to minor tissue damage which often heals while late functionality is more dependent on other factors such as cognitive dysfunction. For patients with whiplash-associated disorders two simple questions should be asked; 'Are you currently easily irritated?' and 'Are you currently easily distracted (e.g. is it difficult for you to follow a conversation if several people are talking in the room at the same time)?'. An affirmative answer to any of these questions indicates an increased risk for poor prognosis defined as sick leave 3 years later. © 2009 Blackwell Munksgaard.

  • 12.
    Peter, Borenstein
    et al.
    Lundby sjukhus, Göteborg.
    S., Linell
    P., Wahrborg
    An innovative therapeutic program for aphasia patients and their relatives1987In: Scandinavian Journal of Rehabilitation Medicine, ISSN 0036-5505, E-ISSN 1940-2228, Vol. 19, no 2, p. 51-56Article in journal (Refereed)
    Abstract [en]

    Eleven aphasia patients and seven family members participated in a five-day residential course led by a speech pathologist, a psychologist and a neurologist. The aim of the course was to give the aphasics and their relatives more information on the etiology, treatment possibilities and prognosis of aphasia; work on personal and interpersonal problems through psychological counseling; improve language function through comprehensive and intensive stimulation; examine the psychological, linguistic and neurological effects of the intensive course. The course participants met again one year after the course and were found to have changed positively both psychologically and interpersonally but, as expected, only to a minor degree linguistically and neurologically. Through this intensive course it was possible to assess the problems of the families more easily than in the hospital. The patients and their relatives reported that they had learnt how to identify and to deal with their psychological problems in a more constructive way. They also felt that they had support from the other families and were able to share their experiences. We found that this type of intervention had many positive effects on the ability of the participants to cope with the chronic disability.

  • 13. W., Iglebekk
    et al.
    C., Tjell
    Peter, Borenstein
    University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
    Treatment of chronic canalithiasis can be beneficial for patients with vertigo/dizziness and chronic musculoskeletal pain, including whiplash related pain2015In: Scandinavian Journal of Pain, Vol. 8, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Background and aim: Chronic musculoskeletal pain, e.g. whiplash associated disorders (WAD), fibromyalgia and myalgia, causes significant burden on both the individual and on society as a whole. In a previous study, the authors concluded that there is a likely connection between chronic benign paroxysmal positional vertigo (BPPV)/canalithiasis and headache, neck pain, generalized pain, fatigue, cognitive dysfunctions as well as tinnitus. The balance dysfunction in BPPV/canalithiasis is dynamic and not static. This leads to a perpetual postural mismatch. The vicious cycle of a disturbed equilibrium control system may be the driving force behind the vicious cycle of pain. The aim of this study is to investigate if otolith-repositioning manoeuvres in patients with chronic BPPV/canalithiasis can be beneficial. Methods: During a period of about two years a prospective observational study on patients with chronic musculoskeletal pain referred for physiotherapy was performed. Those with a Dizziness Handicap Inventory (DHI) inquiry score above 20 underwent further investigations to diagnose chronic BPPV/canalithiasis. Diagnostic criteria: (A) The diagnosis of BPPV/canalithiasis was confirmed with the following: (1) specific history of vertigo or dizziness provoked by acceleration/deceleration, AND (2) nystagmus and symptoms during at least one of the test positions; (B) the disorder had persisted for at least one year. Specific otolith repositioning manoeuvre for each semi-circular canal (SCC) was performed. Symptom questionnaire ("yes" or "no" answers during a personal interview) and a follow-up questionnaire were used. Results: The responders of the follow-up questionnaire constituted the study group. Thirty-nine patients responded (i.e. 87%) (31 females, 8 males) with a median age of 44 years (17-65). The median duration of the disease was 5 years. Seventy-nine percent had a history of head or neck trauma. The DHI median score was 48 points (score >60 indicates a risk of fall). The video-oculography confirmed BPPV/canalithiasis in more than one semi-circular canal in all patients. In the present study the frequency of affected anterior semi-circular canal (SSC) was at a minimum of 26% and could be as high as 65%. Ninety-five percent suffered from headache, 92% from neck pain, 54% had generalized pain, and 56% had temporo-mandibular joint region pain. Fatigue (97%), aggravation by physical exertion (87%), decreased ability to concentrate (85%) as well as visual disturbances (85%) were the most frequently reported symptoms, and 49% suffered from tinnitus. The median number of otolith repositioning manoeuvres done was six (2-29). Median time span between finishing otolith repositioning manoeuvres and answering the questionnaire was 7 months. Effects of treatment and conclusion: The present study has shown that repositioning of otoliths in the SCCs in nearly all patients with chronic BPPV/canalithiasis ameliorated pain and other symptoms. The correlation between vertigo/dizziness and the majority of symptoms was significant. Therefore, there is strong evidence to suggest that there is a connection between chronic BPPV/canalithiasis and chronic pain as well as the above-mentioned symptoms. Implications: Patients with unexplained pain conditions should be evaluated with the Dizziness Handicap Inventory-questionnaire, which can identify treatable balance disorders. © 2015 Scandinavian Association for the Study of Pain.

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