Restorative Neurology and Neuroscience - Volume 14, issue 2-3

Authors: Platz, Thomas | Hesse, S. | Mauritz, K.-H.

Article Type: Research Article

Abstract: A long-term goal in motor rehabilitation is that treatment is not selected on the basis of 'schools of thought', but rather, based on knowledge about efficacy and effectiveness of specific interventions for specific situations (e.g. functional syndromes). Motor dysfunction after stroke or TBI can be caused by many different functional syndromes such as paresis, ataxia, deafferentaion, visuo-perceptual deficits, or apraxia. Examples are provided showing that theory-based analysis of motor behavior makes it possible …to describe 'syndrome-specific motor deficits'. Its potential implications for motor rehabilitation are that our understanding of altered motor behavior as well as specific therapeutic approaches might be promoted. A methodological prerequisite for clinical trials in rehabilitation is knowledge about test properties of assessment tools in follow-up situations such as test-retest reliability and responsiveness to change. Test-retest reliability assesses whether a test can produce stable measures with test repetition, while sensitivity to change reflects whether a test detects changes that occur over time. Exemplifying these considerations, a reliability and validity study of a kinematic arm movement analysis is summarized. In terms of new therapeutic developments, two examples of clinical therapeutic studies are provided assessing the efficacy of specific inter-ventions for specific situations in arm and gait rehabilitation: the Arm Ability Training for high functioning hemiparetic stroke and TBI patients, and the treadmill training for non-ambulatory hemiparetic patients. In addition, a new technical development, a machine-controlled gait trainer ist introduced. Show more

Keywords: TBJ, stroke, movement, arm, gait, therapy, assessment

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 161-166, 1999

Authors: von Steinbüchel, Nicole | Wittmann, Marc | Szelag, Elzbieta

Article Type: Research Article

Abstract: Neuropsychological research on temporal constraints of perception and motor performance can add important information to research on human behavior. Without considering temporal mechanisms of perceiving, generating, and updating information, brain mechanisms can never be fully understood. In this study temporal aspects of performance in psychophysical experiments on three different temporal levels (around 30 ms, 300 ms, and 3000 ms) were investigated in patients with acquired brain lesions and a control group without …neurological deficits. The patients had acquired focal brain lesions in: anterior (pre-central) regions of the left hemisphere (with non-fluent aphasia), posterior (post-central) regions of the left hemisphere (with fluent aphasia), the left hemipshere in predominantly subcortical regions (without aphasia), or anterior (pre-central) or posterior (post-central) regions of the right hemipshere. Perception of temporal order (20 to 60 ms) was impaired in patients with left-hemispheric post-central lesions; repetitive voluntary action (300 to 500 ms) was affected mostly in patients with left hemi-spheric lesions, both pre-central and post-central; and a deficit in integrating (2000 ms to 3000 ms) information was most pronounced in patients with left and right pre-central lesions. These findings provide insight into the associations between different levels of temporal organisation and circumscribed regions of the neocortex. Show more

Keywords: Temporal processing, temporal-order threshold, personal-tapping tempo, maximum-tapping tempo, ambiguous Figures, metronome, brain lesion, cortex,

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 167-182, 1999

Authors: Lotze, Martin | Laubis-Herrmann, U. | Topka, Helge | Erb, M. | Grodd, Wolfgang

Article Type: Research Article

Abstract: Activation maps in the primary motor cortex (M1) were investigated in three patients with complete spinal cord injury (SCI) at level TH3, TH7 and TH9 and in one patient with an incomplete spinal cord injury at level L1 during right elbow (4 patients), right thumb (4 patients), bilateral lip (2 patients) and right foot (3 patients during imagined, 1 patient during executed) movements using functional Magnetic Resonance Imaging (fMRI). Compared to controls fMRI activation maps of …patients with complete paraplegia showed a cranial displacement of the activation maxima in the contralateral primary motor cortex during elbow movement of 13.3mm, whereas the maxima of thumb and lip movements were not altered. The patient with an incomplete spinal cord injury revealed no displacement of elbow activation maxima. The reorganization is likely to occur on the cortical and not on the spinal level. Show more

Keywords: Spinal cord injury, cortical plasticity, reorganization, functional Magnetic Resonance Imaging (fMRI), primary motor cortex

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 183-187, 1999

Authors: Grünewald, Volker | Höfner, Klaus | Thon, Walter F. | Kuczyk, Markus A. | Jonas, Udo

Article Type: Research Article

Abstract: Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical …stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives. Show more

Keywords: neuromodulation, electrical stimulation, sacral nerves, incontinence, detrusor instability, voiding dysfunction

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 189-193, 1999

Authors: Schumacher, Stefan | Bross, Stephan | Scheepe, Jeroen R. | Alken, Peter | Jünemann, Klaus-Peter

Article Type: Research Article

Abstract: The combination of sacral anterior root stimulation (SARS) and posterior rhizotomy is a successful procedure for the restoration of bladder function after supraconal spinal cord injury. Today, complete posterior rhizotomy has become part of the standard therapy. Conventional SARS leads to simultaneous activation of both the detrusor muscle and the external urethral sphincter. We evaluated the possibilities of different neurostimulation techniques to overcome stimulation-induced detrusor-sphincter-dyssynergia and to achieve physiological voiding. Selective detrusor …activation improves current sacral neurostimulation of the bladder, including the poststimulus voiding principle. Selec-tive neurostimulation is possible in the following techniques: anodal block, high-frequency block, depolarizing prepulses, sinusoidal pulses and cryoblock. The anodal block technique and cryotechnique are excellent methods for selective bladder activation to avoid detrusor-sphinc-ter-dyssynergia and thus improve stimulation-induced voiding. Our experience has shown that future modern selective bladder neurostimulation systems will be based on either the anodal block technique or the cryotechnique. Show more

Keywords: sacral nerve roots, selective neurostimulation, posterior rhizotomy, spinal cord injury, bladder control

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 195-199, 1999

Authors: Wang, Xu | Kadner, Alexander | Scheich, Henning

Article Type: Research Article

Abstract: Speech coding strategies for cochlear implants commonly use amplitude modulations of constant high rate pulses to differentially stimulate separate frequency channels in the cochlea. Thereby, time domain information in the fine structure of speech sounds, especially on transients, is largely lost. In gerbils with a single electrode cochlear implant was explored, whether upward and downward interval modulation of pulse trains can carry discriminable information. This question was pursued with unit recordings in primary auditory …cortex (AI) and with behavioral discrimination training in a shuttle box. Units in AI showed multiple differences in the dynamic responses to the two directions of interval modulation and notably ON-response dominated patterns with increasing intervals and OFF-response dominated patterns with decreasing intervals of stimulation. In accordance with these neuronal correlates gerbils learned to distinguish the directions of interval modulation within 3 days, but only with certain specifications. Show more

Keywords: Auditory cortex, learning, temporal analysis, speech coding, rehabilitation

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 201-208, 1999

Authors: Sabel, Bernhard A.

Article Type: Research Article

Abstract: A conference was held in Magdeburg, Germany on March 46 where experts discussed current research in neurotraumatology and neurop-sychological rehabilitation. A total of about 60 research projects of a nationwide program project funded by the German Ministry of Education and Research (BMBF) were presented in conjunction with projects from the BMBF-initiative program Neuropathology of the Otto-v.-Guericke University of Magdeburg and the Graduate Program in Neuroscience which were funded by the German Research …Society (DFG) and the State of Sachsen-Anhalt. The scientific program ranges from molecular, cell biological, anatomical, physiological and behavioral analyses of secondary cell death, regeneration and plasticity to clinical outcome studies and epidemiological evaluations. As such, the conference provides a broad overview of German neuroscience in the areas of neurotrauma, rehabilitation and brain plasticity. The abstracts are part of a special issue of Restorative Neurology and Neuroscience on Neurotrauma and Neuropsychological Rehabilitation which was published on the occasion of the conference. Show more

Citation: Restorative Neurology and Neuroscience, vol. 14, no. 2-3, pp. 209-236, 1999