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Biomedical subjects

S Hesse

Publications and source records attributed to S Hesse.

At least 19 recordsLinked to original sources
PubMed2007

Repetitive locomotor training and physiotherapy improve walking and basic activities of daily living after stroke: a single-blind, randomized multicentre trial (DEutsche GAngtrainerStudie, DEGAS).

OBJECTIVE: To evaluate the effect of repetitive locomotor training on an electromechanical gait trainer plus physiotherapy in subacute stroke patients. DESIGN: Randomized controlled trial. SETTING: Four German neurological rehabilitation centres. SUBJECTS: One hundred and fifty-five non-ambulatory patients (first-time stroke <60 days). INTERVENTION: Group A received 20 min locomotor training and 25 min physiotherapy; group B had 45 min physiotherapy every week day for four weeks. MAIN OUTCOME MEASURES: Primary variables were gait ability (Functional Ambulation Category, 0-5) and the Barthel Index (0-100), blindly assessed at study onset, end, and six months later for follow-up. Responders to the therapy had to become ambulatory (Functional Ambulation Category 4 or 5) or reach a Barthel Index of > or = 75. Secondary variables were walking velocity, endurance, mobility and leg power. RESULTS: The intention-to-treat analysis revealed that significantly greater number of patients in group A could walk independently: 41 of 77 versus 17 of 78 in group B (P B < 0.0001) at treatment end. Also, significantly more group A patients had reached a Barthel Index > or = 75: 44 of 77 versus 21 of 78 (P B < 0.0001). At six-month follow-up, the superior gait ability in group A persisted (54 of 77 versus 28 of 78, P B < 0.0001), while the Barthel Index responder rate did not differ. For all secondary variables, group A patients had improved significantly more (P B < 0.0001) during the treatment period, but not during follow-up. CONCLUSIONS: Intensive locomotor training plus physiotherapy resulted in a significantly better gait ability and daily living competence in subacute stroke patients compared with physiotherapy alone.

Activities of Daily Living↗
PubMed2006

Possible impact of dopamine SPECT on decision-making for drug treatment in Parkinsonian syndrome.

Single-photon emission computed tomography (SPECT) markers allow measuring the integrity of the brain dopaminergic system in vivo. We used dopamine transporter (DAT) SPECT with [(123)I]FP-CIT and dopamine D(2)/D(3) receptor SPECT with [(123)I]IBZM to evaluate whether there is a reduction of DAT and/or D(2)/D(3) receptor SPECT in treated and untreated patients with Parkinsonian syndrome (PS). We found that almost a quarter of our patients treated with anti-Parkinsonian medication prior to SPECT imaging did not show evidence of a presynaptic dopaminergic deficit while 37% of untreated patients were diagnosed as having Parkinson's disease. 17% of treated patients had additional loss of D(2)/D(3) receptor binding capacity in concordance with the clinical follow-up diagnoses of multiple system atrophy, progressive nuclear palsy, and vascular Parkinsonism. Apart from 38% clinically uncertain cases, SPECT was in concordance with 75% of initial clinical diagnoses. 25% were reclassified as indicated by SPECT findings and confirmed by a 1.5-year clinical follow-up. We conclude that dopamine SPECT may support establishing or refuting the clinical diagnosis and, therefore, help to make the decision for or against dopaminomimetic treatment in cases with PS.

Aged↗
PubMed2005

[Mandatory continuing medical education: did the doctors follow the rule? A survey in the state of Vaud].

In 2000, after a deep controversy, the FMH decided to make continuous medical education (CME) compulsory for all physicians practicing in Switzerland. In this study we report the results of two surveys performed between 2000 and 2002 among physicians practicing in the state of Vaud. Our data show that the rule was successfully implemented by most practitioners, both primary care physicians and specialists. This led to a strong increase of the number of encounters between members of the profession as well as an improvement of the quality of the CME, thus showing the relevance of the measure.

Education, Medical, Continuing↗
PubMed2005

Computerized arm training improves the motor control of the severely affected arm after stroke: a single-blinded randomized trial in two centers.

BACKGROUND AND PURPOSE: To compare a computerized arm trainer (AT), allowing repetitive practice of passive and active bilateral forearm and wrist movement cycle, and electromyography-initiated electrical stimulation (ES) of the paretic wrist extensor in severely affected subacute stroke patients. METHOD: A total of 44 patients, 4 to 8 weeks after stroke causing severe arm paresis (Fugl-Meyer Motor Score [FM, 0 to 66] <18), were randomly assigned to either AT or ES. All patients practiced 20 minutes every workday for 6 weeks. AT patients performed 800 repetitions per session with the robot and ES patients performed 60 to 80 wrist extensions per session. The primary outcome measure was the blindly assessed FM (0 to 66), and the secondary measures were the upper limb muscle power (Medical Research Council [MRC] sum, 0 to 45) and muscle tone (Ashworth score sum, 0 to 25), assessed at the beginning and end of treatment and at 3-month follow-up. RESULTS: The AT group had a higher Barthel Index score at baseline, but the groups were otherwise homogenous. As expected, FM and MRC sum scores improved overtime in both groups but significantly more in the robot AT group. The initial Barthel Index score had no influence. In the robot AT group, FM score was 15 points higher at study end and 13 points higher at 3-month follow-up than the control ES group. MRC sum score was 15 points higher at study end and at 3-month follow-up compared with the control ES group. Muscle tone remained unchanged, and no side effects occurred. CONCLUSIONS: The computerized active arm training produced a superior improvement in upper limb motor control and power compared with ES in severely affected stroke patients. This is probably attributable to the greater number of repetitions and the bilateral approach.

Adult↗
PubMed2005

D2 dopamine receptor occupancy, risperidone plasma level and extrapyramidal motor symptoms in previously drug-free schizophrenic patients.

RATIONALE: A relationship between high D2 occupancy (above 80%) and extrapyramidal-motor symptoms under neuroleptic treatment has been observed in several neuroimaging studies. OBJECTIVES: We investigated the striatal dopamine D2 receptor occupancy, risperidone plasma level and extrapyramidal-motor symptoms in drug-free schizophrenic patients. METHODS: Ten schizophrenic patients were treated with 3 - 6 mg risperidone daily. After four weeks administration, a [(123)I]iodobenzamide ([(123)I]IBZM)-single photon emission tomography (SPET) scan for determination of D2 receptor occupancy was carried out (in eight responders) and compared to a control group. Plasma concentrations of risperidone and its active metabolite 9-hydroxyrisperidone (active moiety) were determined by high performance liquid chromatography and electrochemical detection. Extrapyramidal-motor symptoms were assessed by means of the Simpson-Angus-Scale and a handwriting test before treatment and coincident with the scan. RESULTS: The D2 receptor occupancy (Mean 62%, SD 13%) positively correlated with the plasma level of the risperidone active moiety as well as with the reduction in handwriting area. Multiple linear regression revealed an inherent relationship with a coefficient of determination of r = 0.956 (p = 0.02). No clinical relevant extrapyramidal-motor symptoms were observed. CONCLUSIONS: In drug-free schizophrenic responders, the simultaneous assessment of both plasma level and reduction in handwriting area may be a useful clinical tool for a surrogate estimate of D2 receptor occupancy under risperidone treatment. This may help to minimize or even prevent extrapyramidal-motor symptoms.

Adult↗
PubMed2004

[Preoperative imaging as the basis for image-guided neurosurgery].

With the progressive development of soft- and hardware, the acceptance of image-guided neurosurgery has increased dramatically. Additional image data are required to analyze the nature and the dimensions of pathological processes and the surrounding tissue. In this context, fMRI, SPECT, PET, as well as special modalities of CT and MR imaging, are routinely used. Secondary post-processing options are used to detect intracerebral lesions as well as adjacent functional eloquent regions in the parenchymatous organ pre- and intraoperatively. The integration of different image information guarantees the precise planning and realization of surgical maneuvers. The segmentation of interesting structures and risk structures, as well as their implementation in the neuronavigation systems, help to avoid additional intraoperative traumatization and offer a higher level of safety and precision. In this article the value and limitations of presurgical imaging will be discussed.

Brain↗
PubMed2004

Electromechanical gait training with functional electrical stimulation: case studies in spinal cord injury.

STUDY DESIGN: Single case studies. OBJECTIVES: To describe the technique of intensive locomotor training on an electromechanical gait trainer (GT) combined with functional electrical stimulation (FES). SETTING: Neurological Rehabilitation Clinic, Berlin, Germany. METHODS: Four spinal cord-injured (SCI) patients, one tetraparetic, two paraparetic, and one patient with an incomplete cauda syndrome, more than 3 months postinjury, who were unable to walk at all, or with two therapists. They received 25 min of locomotor training on the GT plus FES daily for 5 weeks in addition to the regular therapy. RESULTS: The patients tolerated the programme well, and therapists rated the programme less strenuous compared to manually assisted treadmill training. Gait ability improved in all four patients; three patients could walk independently on the floor with the help of technical aids, and one required the help of one therapist after therapy; gait speed and endurance more than doubled, and the gastrocnemius activity increased in the patients with a central paresis. CONCLUSION: This combined technique allows intensive locomotor therapy in SCI subjects with reduced effort from the therapists. The patients' improved walking ability confirmed the potential of locomotor therapy in SCI subjects.

Electric Stimulation↗
PubMed2004

Aerobic treadmill plus Bobath walking training improves walking in subacute stroke: a randomized controlled trial.

OBJECTIVE: To evaluate the immediate and long-term effects of aerobic treadmill plus Bobath walking training in subacute stroke survivors compared with Bobath walking training alone. DESIGN: Randomized controlled trial. SETTING: Rehabilitation unit. SUBJECTS: Fifty patients, first-time supratentorial stroke, stroke interval less than six weeks, Barthel Index (0-100) from 50 to 80, able to walk a minimum distance of 12 m with either intermittent help or stand-by while walking, cardiovascular stable, minimum 50 W in the bicycle ergometry, randomly allocated to two groups, A and B. INTERVENTIONS: Group A 30 min of treadmill training, harness secured and minimally supported according to patients' needs, and 30 min of physiotherapy, every workday for six weeks, speed and inclination of the treadmill were adjusted to achieve a heart rate of HR: (Hrmax-HRrest)*0.6+HRrest; in group B 60 min of daily physiotherapy for six weeks. MAIN OUTCOME MEASURES: Primary outcome variables were the absolute improvement of walking velocity (m/s) and capacity (m), secondary were gross motor function including walking ability (score out of 13) and walking quality (score out of 41), blindly assessed before and after the intervention, and at follow-up three months later. RESULTS: Patients tolerated the aerobic training well with no side-effects, significantly greater improvement of walking velocity and capacity both at study end (p =0.001 versus p =0.002) and at follow-up (p <0.001 versus p <0.001) in the experimental group. Between weeks 0 and 6, the experimental group improved walking speed and capacity by a mean of.31 m/s and 91 m, the control group by a mean of 0.16 m/s and 56 m. Between weeks 0 and 18, the experimental group improved walking speed and capacity by a mean of 0.36 m/s and 111 m, the control group by a mean of 0.15 m/s and 57 m. Gross motor function and walking quality did not differ at any time. CONCLUSIONS: Aerobic treadmill plus Bobath walking training in moderately affected stroke patients was better than Bobath walking training alone with respect to the improvement of walking velocity and capacity. The treatment approach is recommended in patients meeting the inclusion criteria. A multicentre trial should follow to strengthen the evidence.

Aged↗
PubMed2004

Recovery of gait and other motor functions after stroke: novel physical and pharmacological treatment strategies.

The gait-lab at Klinik Berlin developed and evaluated novel physical and pharmacological strategies promoting the repetitive practise of hemiparetic gait in line with the slogan: who wants to relearn walking, has to walk. Areas of research are treadmill training with partial body weight support, enabling wheelchair-bound subjects to repetitively practice gait, the electromechanical gait trainer GT I reducing the effort on the therapists as compared to the manually assisted locomotor therapy, and the future HapticWalker which will allow the additional practise of stair climbing up and down and of perturbations. Further means to promote gait practice after stroke was the application of botulinum toxin A for the treatment of lower limb spasticity and the early use of walking aids. New areas of research are also the study of D-Amphetamine, which failed to promote motor recovery in acute stroke patients as compared to placebo, and the development of a computerized arm trainer, Bi-Manu-T rack, for the bilateral treatment of patients with a severe upper limb paresis.

Botulinum Toxins, Type A↗
PubMed2003

The degree of depression in Hamilton rating scale is correlated with the density of presynaptic serotonin transporters in 23 patients with Wilson's disease.

OBJECTIVE: One of the most frequent psychiatric symptoms in patients with Wilson's disease (WD) is depression. It has been suggested that depression is associated with deficits in serotonergic neurotransmission, but, hitherto, no measurements have been performed in WD. METHODS: We prospectively examined 23 adult patients (12 women, 11 men, mean age 40 years) with WD for symptoms of depression using the Hamilton rating scale for depression (HAMD). We correlated the data with the presynaptic serotonin transporter density (SERT density) in the thalamus-hypothalamus and the midbrain-pons regions measured with high resolution single-photon emission computed tomography (SPECT) 24 hours after the application of 180 MBq 2beta-carbomethoxy-3beta-(4 [(123)I]iodophenyl)tropane ( [(123)I]b-CIT). The regions of interest were determined by coregistration with a standard MRI dataset. RESULTS: A significant negative correlation was found between HAMD and SERT density in the thalamus-hypothalamus region (r = -0.49, p = 0.02), but not in the midbrain-pons (r = -0.31, p = 0.15). CONCLUSIONS: We conclude that depression in patients with Wilson's disease is correlated with alterations of serotonergic neurotransmission in the thalamus-hypothalamus region.

Adult↗
PubMed2003

Regional serotonin transporter availability and depression are correlated in Wilson's disease.

In patients with Wilson's disease (WD), depression is a frequent psychiatric symptom. In vivo neuroimaging studies suggest that depression and other neuropsychiatric disorders are associated with central serotonergic deficits. However, in vivo measurements of serotonergic neurotransmission have not until now been performed in patients with this copper deposition disorder. The present prospective study revealed that depressive symptomatology is related to an alteration of presynaptic serotonin transporters (SERT) availability as measured by [123I]-2beta-carbomethoxy-3beta-(iodophenyl)tropane ([123I]beta-CIT) and high-resolution single-photon emission computed tomography (SPECT). SERT imaging with [123I]beta-CIT-SPECT could therefore become a useful tool for diagnosis and therapy monitoring in depressed WD patients.

Adult↗
PubMed2003

In vivo measurement of the serotonin transporter with (S)-([18F]fluoromethyl)-(+)-McN5652.

The radiolabeled serotonin transporter (SERT) ligand [(11)C](+)-McN5652 has recently been used in clinical positron emission tomography (PET) studies for SERT imaging. However, this radioligand offers disadvantages in routine clinical settings because of its short radioisotope half-life (eg PET facilities within hospitals without a cyclotron need to acquire such radioligands from distant cyclotron units for clinical use). S-([(18)F]fluoromethyl)-(+)-McN5652 ([(18)F](+)-FMe-McN5652) is an analogue which has been synthesized newly, and has a significantly longer radioisotope half-life. In the porcine brain, it demonstrates the same characteristic distribution pattern of serotonin-uptake sites like the (11)C-labeled congener with the highest binding in the midbrain and thalamus and the lowest in the cerebellum and occipital cortex. It shows a 30% higher blood-brain transfer and a slower peripheral metabolism than [(11)C](+)-McN5652. Rather uniform brain binding was observed after injection of the pharmacologically inactive radiolabeled enantiomer, or after pretreatment with the highly selective SERT inhibitor citalopram. The norepinephrine uptake inhibitor maprotiline did not show any inhibitory effect. Using a one-tissue compartment model (K(1), k"(2)) or a two-tissue compartment model (K(1) to k(4)) with or without constraints for calculation, the regional binding parameters of [(11)C](+)-McN5652 and [(18)F](+)-FMe-McN5652 are highly correlated among each other and with the SERT density, as determined by in vitro binding of [(3)H]citalopram. Using constraints to correct for the free fraction and nonspecific binding of the radiotracers, a considerable increase of the midbrain-occipital cortex ratios with higher values for [(18)F](+)-FMe-McN5652 compared to [(11)C](+)McN5652 was revealed. It is concluded that [(18)F](+)-FMe-McN5652 has better features than [(11)C](+)McN5652 for SERT imaging with PET.

Animals↗
PubMed2003

[Development of a robotic walking simulator for gait rehabilitation].

Restoration of gait is a major concern of rehabilitation after stroke or spinal cord injury. Modern concepts of motor learning favour a task-specific repetitive approach, i.e. "whoever wants to learn to walk again must walk." However, the physical demands this places on the therapist, is a limiting factor in the clinical routine setting. This article describes a robotic walking simulator for gait training that enables wheelchair-bound subjects to freely carry out repetitive practicing of an individually adapted gait pattern under simulation of the manual guidance of an experienced therapist. The technical principle applied makes use of programmable footplates with permanent foot/machine contact in combination with compliance control. The solution chosen comprises a planar parallel-serial hybrid kinematic system with three degrees of freedom that moves the feet in the sagittal plane. Gait analysis while floor walking and stair climbing, clinical practicability and safety aspects were the basis for the design. A variable compliance control enables man-machine interaction, ranging from purely position controlled movement to full compliance during swing phase above a virtual ground profile. In full compliance mode the robotic walking simulator behaves like a haptic device. The concept presented offers new prospects for individualized gait rehabilitation.

Artificial Intelligence↗
PubMed2002

[Suspicious pigmented skin lesions. Screening campaign by occupational physicians in the Provence-Alpes-Côte d'Azur region].

OBJECTIVE: Cutaneous melanoma prevention has become a public health issue. The incidence of this cancer has been steadily growing for 50 years, and the related death ratio is not decreasing. Today, the surgical resection of a thin lesion is the only validated curative treatment. The early detection of melanoma represents a major line in the management of such tumours. METHODS: Occupational physicians of the PACA area were invited to participate in a campaign for the screening of pigmented suspect cutaneous lesions for 2 years. Voluntary physicians were trained to use the ABCDEF diagnostic criterion. Lesions were detected during regular yearly consultations (1998/1999) and the data concerning the development and care of these lesions was collected during consultations over the following year (1999/2000). RESULTS: Two hundred and fifty occupational physicians of the PACA area participated in the campaign. Two pre-cancerous lesions and 10 cancers (5 melanoma and 5 pigmented basocellular carcinoma) were found among the 487 suspect lesions detected. Each melanoma had a Breslow score of less than 0.9 mm and were of good or even excellent prognosis. CONCLUSION: The cutaneous examination, although rapid, during the occupational medicine consultations, is an effective means of detecting the early onset tumoral lesions which, at that stage may potentially be cured. The ABCDEF criterion is a useful diagnostic tool and should be taught to the all the medical and paramedical staff.

Adult↗
PubMed2002

Fractionation of natural organic matter in drinking water and characterization by 13C cross-polarization magic-angle spinning NMR spectroscopy and size exclusion chromatography.

Natural organic matter from drinking water sources was fractionated, and the fractions were characterized by NMR and SEC with the aim of relating NOM structure to treatability. Organic matter was isolated from two Australian surface waters (Horsham, Moorabool) by reverse osmosis and from a groundwater (Wanneroo) by anion exchange. The isolates were fractionated according to polarity and charge by resin adsorption. 13C NMR spectra of the freeze-dried fractions showed the most hydrophobic fraction to be high in aliphatic and aromatic carbon while slightly hydrophobic organics have more carbonyl and alkoxyl carbon. The Horsham and Wanneroo hydrophilic fractions show strong alkoxyl signals attributed to carbohydrate. Moorabool hydrophilics contain aromatic (phenolic) carbon; the apparent absence of carbohydrate appears to be an artifact. Size-exclusion chromatograms were recorded on the original and fractionated organics with both UV and dissolved organic carbon detection. The Horsham and Moorabool organics have similar molecular size distributions while Wanneroo is dominated by strongly absorbing species having large hydrodynamic radii. The hydrophobic and charged hydrophilic fractions also have high apparent MW, while the neutral fraction is higher in low-MW compounds of relatively low specific absorbance, suggestive of carbohydrates.

Carbohydrates↗
PubMed2002

Management of upper and lower limb spasticity in neuro-rehabilitation.

This article reviews the treatment of upper and lower limb spasticity in neurological rehabilitation. Botulinum toxin A proved effective in several placebo-controlled studies reducing muscle tone, easing hand hygiene and nursing, improving upper limb motor functions and gait ability. The effects are reversible and the toxin is well tolerated. Electrical stimulation, tonic stretch post injection and the active use of the treated extremity are means to increase the effectiveness of the costly therapy. Phenol 5% is an alternative in case of budget constraints, but the technique is demanding and side effects are more frequent. Further, task-specific repetitive therapy should follow the successful treatment of focal spasticity in eligible patients to get the maximum profit with regard to disability.

Arm↗