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Konstanz, Germany

Liepert J.,Kliniken Schmieder
Journal fur Neurologie, Neurochirurgie und Psychiatrie | Year: 2010

An increasing number of publications dealing with motor rehabilitation now allows to denominate evidence-based therapies. In this review, old and new treatments for motor rehabilitation of upper and lower limbs after stroke will be presented. In particular, randomised, controlled trials, meta-analyses and systematic reviews have been taken into consideration. In summary, evidence is best for constraint-induced movement therapy and for application of botulinum toxin type A in patients with focal spasticity. Some efficacy has been demonstrated for other therapies such as impairment-oriented training, mirror therapy, mental practice, the use of electromechanical devices and specific gait training. Without doubt, further scientific research is required for already well-known as well as new treatment strategies. Source

Hassa T.,Kliniken Schmieder Allensbach | Schoenfeld M.A.,Kliniken Schmieder Allensbach | Schoenfeld M.A.,Otto Von Guericke University of Magdeburg | Schoenfeld M.A.,Leibniz Institute for Neurobiology | And 4 more authors.
Restorative Neurology and Neuroscience | Year: 2011

Purpose: Recent evidence from neuroimaging studies using visual tasks suggests that the right superior parietal cortex plays a pivotal role for the recovery of neglect. Importantly, neglect-related deficits are not limited to the visual system and have a rather multimodal nature. We employed somatosensory stimulation in patients with neglect in order to analyze activity changes in networks that are presumably associated with this condition. Methods: Eleven chronic neglect patients with right hemispherical stroke were investigated with a fMRI paradigm in which the affected and unaffected hand were passively moved. Results: Brain activation was correlated with the performance in clinical neglect tests. Significant positive correlations with brain activation were found for the lesion duration, the performance in bells and letter cancellation tests and the line bisection test. These activated areas formed a distributed pattern in the right superior parietal cortex. Conclusions: The results suggest a shared representation of visual and somatosensory networks in the right superior parietal cortex in patients with right hemispherical strokes and neglect. The spatial pattern of activity in the superior parietal cortex points out to a different representation of changes related to lesion duration and neglect. © 2011 - IOS Press and the authors. All rights reserved. Source

Liepert J.,Kliniken Schmieder
Current Opinion in Neurology | Year: 2010

Purpose of review: The diversity of interventions aimed at improving upper extremity dysfunction is increasing. This article reviews the effectiveness of different therapeutic approaches that have been published in 2009 and 2010. Evidence is based on randomized controlled trials, systematic reviews, and meta-analyses. Recent findings: Application of constraint-induced movement therapy in acute stroke patients was not more effective than a control intervention, and a more intense therapy may even be harmful. Botulinum toxin injections do not only reduce spasticity but, in children, also improve motor functions if combined with occupational therapy. Strength training improves arm function but not necessarily activities of daily living. Bilateral arm training is as effective as other interventions. Extrinsic feedback and sensory training may further improve motor functions. Mirror therapy was particularly effective for patients with initial hand plegia. Summary: For some interventions (e.g. constraint-induced movement therapy, botulinum toxin), efficacy is evident, for others (e.g. mental practice, virtual reality), well designed studies with sufficient numbers of patients are needed. The ultimate goal still is to develop evidence-based therapies for all different degrees of motor impairment. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins. Source

Greiner J.,Kliniken Schmieder | Schoenfeld M.A.,Kliniken Schmieder | Schoenfeld M.A.,Otto Von Guericke University of Magdeburg | Schoenfeld M.A.,Leibniz Institute for Neurobiology | Liepert J.,Kliniken Schmieder
Archives of Gerontology and Geriatrics | Year: 2014

Objective: This study examined the temporal congruency between real and imagined movements and explored intermanual transfer effects in healthy subjects. Methods: Seventy-six right-handed healthy subjects were allocated to three age groups and tested with a modified version of the Box and Block Test (BBT). We focussed on two aspects. First, the BBT was evaluated with respect to its ability to assess MC. Second, we were interested whether performance of motor imagery (MI) and real execution with one hand would modify performance with the other hand. To explore MC, we measured motor execution (ME) time as the time needed to perform the BBT, and MC time as the time difference between ME and the time needed for imagination of task execution. The BBT was performed with both hands consecutively to study transfer effects from one hand to the other and then repeated with the first hand for practice effects. Results: The age group with the oldest subjects exhibited a slower BBT performance and a less precise MC than the other 2 age groups. Irrespective of the age, MC abilities could be transferred to the other hand, whereas ME only improved when repeating the task with the same hand. Conclusions: The BBT was able to demonstrate an age-related decline of dexterity and MC. Intermanual transfer of MI abilities occurred even after a single run. © 2013 Elsevier Ireland Ltd. Source

Liepert J.,Kliniken Schmieder | Heller A.,Kliniken Schmieder | Behnisch G.,Leibniz Institute for Neurobiology | Schoenfeld A.,Leibniz Institute for Neurobiology | Schoenfeld A.,Otto Von Guericke University of Magdeburg
Neurorehabilitation and Neural Repair | Year: 2013

Background. To explore whether a polymorphism in dopamine metabolism influences the effectiveness of neurological rehabilitation and the outcome after ischemic stroke. Methods. The Barthel Index (BI) and the Rivermead Motor Assessment (RMA) were assessed in 78 moderately affected stroke patients (1) after they had entered a neurological inpatient rehabilitation, (2) after 4 weeks of rehabilitation therapy, and (3) 6 months later. Polymorphisms of the gene encoding catechol-O-methyltransferase (COMT) were determined. BI and RMA results were analyzed with respect to the genetic profiles of COMT. Results. Carriers of COMT Val/Val alleles showed better results in BI and RMA than COMT Met/Met carriers at all 3 time points. Val/Met carriers exhibited results in between the homozygotes, suggesting a gene-dose relationship. Altogether, BI and RMA results were highly correlated. Conclusion. Stroke patients with COMT Val/Val alleles had higher motor functions and abilities of activities of daily living even at the beginning of the rehabilitation period. All patient groups improved during the rehabilitation period to a similar degree, suggesting that physical therapy is comparably effective in all polymorphism subtypes. © The Author(s) 2013. Source

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