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Lina Bunketorp Käll

Researcher

Department of Health and
Rehabilitation
Telephone
Visiting address
C.A.R.E., SU/Mölndal, Hus U1, vån 6
43180 Mölndal
Postal address
C.A.R.E., SU/Mölndal, Hus U1, vån 6
43180 Mölndal

About Lina Bunketorp Käll

Research: Cervical and Nervous System Injuries and Associated Disorders – investigation and treatment

Summary

The sophisticated nervous system that is responsible for the coordination and regulation of bodily functions is involved in many different injuries, disorders and diseases. Its complexity but also unique ability to repair and heal itself enables new methodology and exciting research. Medical advances and increased knowledge of the regenerative capacity of the nervous system have led to the development of new treatment strategies and innovative multimodal, surgical and high-tech solutions to promote functional recovery in various disease states.

The focus of the research is largely on intervention research with a focus on methods that aim to increase the functional ability, participation and quality of life of individuals with chronic pain, brain injuries and spinal cord injuries. By advanced brain imaging we study mechanisms that can explain possible treatment effects as well as variations in treatment outcomes.

Research areas

The research can be divided into the following areas

  • Multimodal interventions for individuals with acquired brain injury
  • Advanced surgical reconstruction for increased upper limb function in cervical spinal cord injury and spasticity-related conditions.
  • Neural mechanisms in case of illness or injury
  • Prolonged pain - investigation, diagnosis and treatment
  • Physical function in an aging perspective

DESCRIPTION OF SPECIFIC PROJECTS

MULTIMODAL INTERVENTIONS FOR INDIVIDUALS WITH ACQUIRED BRAIN INJURY

With an interdisciplinary approach, we study the effects of horse-riding therapy, music and rhythm therapy and intensive training in an enriched environment for individuals in late phase after stroke. The research is based on the notion that multisensory stimulation, activation and exercise can accelerate the brain's recovery after injury and healing of both motor and cognitive function. Blood samples have been collected within the framework of the studies with the aim of studying potential biomarkers that can predict the treatment outcome. The participants have also undergone in-depth interviews to examine how the intervention is perceived to have affected the participants' everyday life and activity performance in general.

PhD project

The effect of high-intensity training combined with an enriched environment - Sara Vive

Animal studies have shown that an enriched environment - which includes social interaction, physical activity, sensory and cognitive stimulation as well as task-specific training - has been shown to be a way to use and strengthen the brain's plasticity and reorganization and contribute to recovery after stroke. In the current PhD project, the effect of intensive training in an enriched environment for stroke sufferers is evaluated. The overall aim is to investigate whether it is possible to improve function and activity performance for individuals in a late phase after stroke with a rehabilitation program consisting of high-intensity task-specific, goal-oriented training in an enriched environment. The intervention takes place in Spain, at a rehabilitation facility outside Marbella. In a parallel pilot study, we include individuals with traumatic brain injuries who undergo the same rehabilitation program. Advanced analysis of participants’ gait and its various components as well as the pattern of load during a sit-to-stand procedure is conducted in collaboration with Lundberg's laboratory with the latest technology in the field. Sara Vive defended her thesis on May 6, 2021 (Sara Vive - Enriched, task specific therapy in the chronic phase after stroke | Göteborgs universitet (gu.se)

ADVANCED SURGICAL RECONSTRUCTION FOR IMPROVED UPPER LIMB FUNCTION IN INDIVIDUALS WITH CERVICAL SPINAL CORD INJURIES AND SPASTICITY-RELATED CONDITIONS

At the Center for Advanced Reconstruction of Legs (CARE), Sahlgrenska Hospital in Gothenburg (Centrum för avancerad rekonstruktion av extremiteter mottagning - Sahlgrenska Universitetssjukhuset), surgical reconstruction of upper limb function is done to improve arm and hand function in individuals suffering from paralysis or spasticity following injuries to the central nervous system such as spinal cord injury, stroke and traumatic brain injury. In grip-reconstructive surgery, functioning muscles are mainly used, which are transferred to a new position in order to be able to perform important grip functions. Recently, another innovative form of surgical treatment has been launched, which involves restoring the opening ability of the hand by means of nerve transfer. Transferring nerves means that nerve fibers to muscles on the upper arm that still have their function intact are cut off in the transition between nerve and muscle, moved and connected to a nerve to the paralyzed muscle that is to perform the movement. After a number of months of nerve growth, the recipient muscle has begun to receive nerve impulses. The preliminary results are very promising and show functioning nerve growth and that the hand's opening ability has been recreated. During nerve growth, the patient may undergo surgical reconstruction of grip functions. By combining these two procedures, the conditions for an active life with the lowest possible degree of dependence can be optimized in individuals with spinal cord injuries. In a project funded by ALF and the Swedish Research Council, we intend to compare functional benefits and activity gains between individuals who undergo grip reconstruction in isolation, with those who undergo combined intervention (nerve transfer + grip reconstruction). We also aim to study neuroplastic mechanisms in connection with these treatments.

PhD project

Evaluation of a surgical spasticity-reducing treatment concept for focal spasticity in upper extremity - Therese Ramström

At C.A.R.E. spasticity-correcting surgery is performed with the aim to increase independence or facilitate care of patients who have troublesome spasticity in the upper extremity after neurological injuries. In the current PhD project, we intend to compare the outcome after spasticity-correcting surgery with botulinum toxin treatment. The study is carried out in collaboration with Rehabilitation Medicine, SU / Högsbo Hospital.

FUNCTIONAL NEUROIMAGING TO WIDEN THE KNOWLEDGE OF LINKAGES BETWEEN NEURAL MECHANISMS AND MOTOR FUNCTION / BEHAVIOR / PAIN CONDITION

The latest development of brain imaging methods enables interesting studies of the brain’s reorganization and its plastic properties in the investigation or treatment of conditions such as pain or various injuries. Functional near-infrared spectroscopy (fNIRS) is a promising new method for locating and quantifying sensory and motor activity in patients with damage to both the peripheral and central nervous systems. fNIRS measures the light absorption in the blood's hemoglobin, which varies with oxygenation. This varying oxygenation in turn, provides information about brain activity in a similar way as functional magnetic resonance imaging (fMRI). Both methods allow indirect quantification of brain activation due to the link between neural activity and local changes in blood flow and blood oxygenation. The goal has been to build up competence in Gothenburg with a focus on primarily mechanisms behind motor recovery after injury, cortical reorganization, sensory and cognitive function. In collaboration with the Biomedical Optics Research Laboratory, Department of Medical Physics and Biomedical Engineering, University College London, United Kingdom, our first goal has been to study brain activation patterns in tasks involving elbow flexion and key pinch in individuals who have undergone grip reconstruction due to paralysis after spinal cord injury. The project includes both functional near-infrared spectroscopy (fNIRS) and fMRI. Other ongoing studies have focus on cognitive function linked to the brain's neural activity in various disease states.

Today's lack of effective treatments for phantom limb pain means that the majority of amputees have to sustain their severe pain. In a collaborative project with Chalmers as principal investigator (Center for Bionics and Pain Research (cbpr.se) an innovative method for the treatment of phantom limb pain called Neuromotus is being evaluated. The method - a kind of virtual motor training, which is believed to stimulate the brain's neuroplastic properties is based on a unique combination of several different technologies and compensates for the weaknesses of available methods. The project uses brain imaging techniques to study mechanisms behind the pain condition as well as mechanisms behind successful treatment with virtual motor training.

Completed PhD project

Shedding light on cognitive control - Simon Skau

In the current doctoral thesis, cognitive control and its underlying cortical activation have been studied (Simon Skau - "Shedding light on cognitive control" - http://hdl.handle.net/2077/63617).

WHIPLASH – ASSOCIATED DISORDERS AND MYALGIC ENCEPHALOMYELITE / CHRONIC FATIGUE SYNDROME; INVESTIGATION, DIAGNOSIS AND TREATMENT

PhD project

Whiplash-associated disorders in a patient, healthcare and health perspective - Yvonne Severinsson

The current doctoral project aims to investigate residual disorders in the late phase after whiplash injury. A study involving the region’s primary care units that offer multimodal rehabilitation (MMR) aims to study whether the MMR team's organization, content and measures could be linked to sick leave / work status after MMR. The individuals' experiences after completing the MMR program are also studied.

Myalgic encephalomyelitis / chronic fatigue syndrome (ME / CFS) often involve severe fatigue and exhaustion that knocks out the person's previous activity levels. Associated conditions include fibromyalgia and long-term symptoms after neck-head trauma - Wiplash associated disorders (WAD) and post-consussion syndrome, the latter with overlapping symptoms in the form of impaired memory, neck pain, headache and fatigue. In a doctoral thesis at KI (Gabriella Bernhoff) studies are ongoing regarding ME / CFS and associated conditions with a focus on improved management, investigation and diagnostics in primary care, to investigate a possible connection with instability / nerve impact in the cervical region, to investigate the usefulness of complaints as a diagnostic method to demonstrate instability / nerve impact and finally to analyze patient perspective on care and information about ME / CFS and associated conditions.

PHYSICAL FUNCTION IN AN AGING PERSPECTIVE

PhD project

Mechanical muscle function and functional capacity and effect of aging - Cecilia Elam

With increasing age, body composition and neuromuscular functions change; the proportion of fat increases and the amount of muscle mass decreases, muscle function and balance deteriorate, as well as the elastic properties of muscles and tendons. With this comes an increased risk of falls and further impaired function, deteriorating health and quality of life. In an ongoing doctoral thesis (Cecilia Elam), differences in muscle function among men and women are studied, as well as how the ability to quickly develop power changes with age. In collaboration with the Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark, the effect of immobilization and subsequent rehabilitation on maximum muscle strength, postural control and functional ability in young and older men is evaluated.