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S Hesse

Publications and source records attributed to S Hesse.

At least 37 records · Page 2Linked to original sources
PubMed2002

Comparison of clinical types of Wilson's disease and glucose metabolism in extrapyramidal motor brain regions.

In Wilson's disease a disturbed glucose metabolism especially in striatal and cerebellar areas has been reported. This is correlated with the severity of extrapyramidal motor symptoms (EPS). These findings are only based on a small number of patients. Up to now it is unknown whether EPS are caused by various patterns of disturbed basal ganglia glucose metabolism. We investigated 37 patients and 9 normal volunteers to characterize the disturbed glucose metabolism in Wilson's disease more precisely. The glucose metabolism was determined in 5 cerebellar and cerebral areas (putamen, caput nuclei caudati, cerebellum, midbrain and thalamic area) by using (18)F-Fluorodesoxyglucose-Positron-Emission-Tomography ( [(18)F]FDG-PET). The database was evaluated by a cluster analysis. Additionally, the severity extrapyramidal motor symptoms were judged by a clinical score system. Three characteristic patterns of glucose metabolism in basal ganglia were obtained. Two of them may be assigned to patients with neurological symptoms whereas the third cluster corresponds to most patients without EPS or normal volunteers. The clusters can be identified by characteristic consumption rates in this 5 brain areas. The severity of EPS can not clearly be assigned to one of the clusters with disturbed glucose metabolism. However, the most severe cases are characterized by the lowest consumption in the striatal area. When there is marked improvement of EPS impaired glucose consumption reveals a persistent brain lesion. Finally, the neurological symptoms in Wilson's disease are caused by (at least) two different patterns of disturbed glucose metabolism in basal ganglia and cerebellum. The severity of EPS seems to be determined by a disturbed consumption in the striatal area.

Adult↗
PubMed2002

Treadmill training with partial body weight support and physiotherapy in stroke patients: a preliminary comparison.

Treadmill training with partial body weight support can restore the gait ability of chronic non-ambulatory hemiparetic subjects. A combination of physiotherapy and treadmill training may accelerate the rate of recovery. Therefore a randomized study was planned. Twenty-eight non-ambulatory hemiparetic patients were randomly assigned to group A or B. A 3-week baseline of conventional therapy was followed by 15 sessions of physiotherapy and treadmill training in patients of group A and by 15 sessions of treadmill training in patients of group B over a period of 3 weeks. Follow-up was 4 months later. The major outcome variables were gait ability and ground level walking velocity. Gait ability and velocity did not change during the baseline. In group B, five patients became independent walkers after the specific intervention, whereas 10 patients of group A regained independent walking ability in the same period (P < 0.05). Four months later group differences had waned. Three weeks of treadmill training plus physiotherapy accelerated the restoration of gait ability in hemiparetic subjects, however, the double amount of therapy in group A does not exclude a simple dose-response phenomenon.

Adult↗
PubMed2002

Treadmill training with partial body weight support and an electromechanical gait trainer for restoration of gait in subacute stroke patients: a randomized crossover study.

BACKGROUND AND PURPOSE: The purpose of this study was to compare treadmill and electromechanical gait trainer therapy in subacute, nonambulatory stroke survivors. The gait trainer was designed to provide nonambulatory subjects the repetitive practice of a gait-like movement without overexerting therapists. METHODS: This was a randomized, controlled study with a crossover design following an A-B-A versus a B-A-B pattern. A consisted of 2 weeks of gait trainer therapy, and B consisted of 2 weeks of treadmill therapy. Thirty nonambulatory hemiparetic patients, 4 to 12 weeks after stroke, were randomly assigned to 1 of the 2 groups receiving locomotor therapy every workday for 15 to 20 minutes for 6 weeks. Weekly gait ability (functional ambulation category [FAC]), gait velocity, and the required physical assistance during both kinds of locomotor therapy were the primary outcome measures, and other motor functions (Rivermead motor assessment score) and ankle spasticity (modified Ashworth score) were the secondary outcome measures. Follow-up occurred 6 months later. RESULTS: The groups did not differ at study onset with respect to the clinical characteristics and effector variables. During treatment, the FAC, gait velocity, and Rivermead scores improved in both groups, and ankle spasticity did not change. Median FAC level was 4 (3 to 4) in group A compared with 3 (2 to 3) in group B at the end of treatment (P=0.018), but the difference at 6-month follow up was not significant. The therapeutic effort was less on the gait trainer, with 1 instead of 2 therapists assisting the patient at study onset. All but seven patients preferred the gait trainer. CONCLUSIONS: The newly developed gait trainer was at least as effective as treadmill therapy with partial body weight support while requiring less input from the therapist. Further studies are warranted.

Body Weight↗
PubMed2001

[Ambulatory rehabilitation exercises for stroke patients at home. Preliminary results of scope, methods and effectiveness].

AIM: This study was intended to examine extent, content, and effectiveness of outpatient physiotherapy in stroke patients. METHODS: Seventy-four first-time stroke survivors were included who had a mean Barthel index (BI) of 55.6 when discharged home. A questionnaire asked about the extent, content, and satisfaction with their outpatient physiotherapy over the previous 6 months and scored the items of the BI and the gross functions of the Rivermead Motor Assessment Score (RMS). RESULTS: Fifty of 54 patients had received ongoing physiotherapy, mean intensity was 90.2 min/week (SD 60.9) with a mean of 2.9 (range 1 to 5) sessions/week. Eighty-four per cent of the patients were content and rated the therapist as their most important social contact out of family. The BI and RMS remained stable. Therapy intensity did not correlate with their individual course. CONCLUSIONS: The moderately affected stroke patients received a great amount of therapy. They were content and had maintained their activity level. However, the individually varying therapy intensity did not correlate with any individual activity changes. Further studies are needed that take modern therapy concepts into account.

Activities of Daily Living↗
PubMed2001

Body weight-supported treadmill training after stroke.

Gait rehabilitation is a major aspect of neurologic rehabilitation. This review focuses on locomotor therapy by treadmill stimulation with partial body weight support (BWS), which has become a very promising treatment concept over the past few years. It enables severely affected patients to follow modern aspects of motor learning, favoring a task-specific approach. Initially two therapists assist the movement, placing the paretic limbs and controlling the trunk movements. As compared with overground walking, patients walked more symmetrically, less spastically, and more efficiently on the treadmill with BWS. Several clinical controlled studies have shown its potential in patients after stroke, who regained walking ability faster in the acute or in the chronic stage. Controlled multicenter trials comparing locomotor and conventional therapy will be the next step. Also, the use of BWS during overground walking could be incorporated into the locomotor treatment program of less affected stroke patients. An electromechanical gait trainer relieving the strenuous effort of the therapists and controlling the trunk in a phase-dependent manner is a new technical alternative for severe stroke patients.

Body Weight↗
PubMed2001

Influence of walking speed on lower limb muscle activity and energy consumption during treadmill walking of hemiparetic patients.

OBJECTIVE: To identify the relationship between treadmill speed and energy consumption and lower limb muscle activity in ambulatory hemiparetic patients. DESIGN: Experimental cohort. SETTING: Inpatient rehabilitation clinic. PARTICIPANTS: Twenty-four ambulatory hemiparetic subjects. INTERVENTION: Subjects walked harness-secured on the treadmill with no body-weight support at self-reported (V SAS), slow (V SAS - 25%), and fast (V SAS + 25%) speed. MAIN OUTCOME MEASURES: Assessment of basic, limb-dependent cycle parameters, lower limb muscle activity, and energy consumption. RESULTS: Cadence (r = .75), stride length (r = .78), relative double-support duration (r = .31), mean muscle activity of the paretic tibialis anterior (r = .12), gastrocnemius (r = .37), vastus lateralis (r =.19), rectus femoris (r = .31), and biceps femoris (r = .45) muscles, as well as heart rate (r = .54), correlated positively with treadmill speed. Mean maximum heart rate was 131 beats/min. Energy (r = -.67) and cardiac cost (r = -.55) correlated negatively with gait speed (ie, patients walked more efficiently at faster velocities). The qualitative muscle activation pattern analysis revealed earlier (more normal) onset of activation of gastrocnemius, vastus lateralis, biceps femoris, and gluteus medius. CONCLUSIONS: Patients should try to walk fast on the treadmill, thereby facilitating relevant weight-bearing muscles and improving gait efficiency.

Aged↗
PubMed2001

Positron emission tomography with [(18)F]fluoro-2-deoxy-D-glucose for diagnosis and staging of bile duct cancer.

Malignant tumors with high glucose metabolic rates accumulate [18F]-fluorodeoxyglucose (FDG), a positron emitting tracer. The aim of this study was to evaluate FDG positron emission tomography (PET) for detection and staging of human cholangiocarcinoma (CC). Patients with adenocarcinoma of the biliary tree (n = 26), with benign lesions of the bile ducts (n = 8), and 20 control patients underwent FDG-PET (370 MBq [18F]-FDG, Siemens ECAT EXACT HR(+)). In a blinded fashion, 4 independent experts evaluated the PET scans visually and semiquantitatively using the standardized uptake value and a tumor/non-tumor ratio. All adenocarcinomas and benign lesions (sclerosing cholangitis, bile duct adenoma, Caroli's disease) were histologically proven and imaged by magnetic resonance imaging and endoscopic retrograde cholangioscopy. True-positive PET scans were obtained in 24 of 26 CC and false-negative scans in the other 2 (sensitivity 92.3%). The PET scan was true-negative in 18 of 20 controls and in all 8 benign biliary lesions (specificity 92.9%). Visual and semiquantitative evaluation using tumor/non-tumor ratios were equally accurate (accuracy 92.6%) whereas evaluation by standardized uptake value revealed lower accuracy (P <.05). Regional or hepatoduodenal lymph node metastases were detected with PET in only 2 of 15 cases whereas distant metastases (peritoneal carcinomatosis, pulmonary metastases) were diagnosed in 7 of 10 cases. In conclusion, PET is highly sensitive and specific for the detection and localization of CC. It can be helpful for diagnosis of distant metastases but is not suitable for detection of regional lymph node metastases.

Adenocarcinoma↗
PubMed2001

[18F-FDG positron-emission-tomography in cervical carcinoma: preliminary findings].

18F-Fluorodesoxyglucose-Positron-Emission-Tomography (18F-FDG-PET) is a novel imaging modality for malignancies. This study was initiated to define the efficiency of PET in detecting and characterizing metabolically the primaries and in preoperatively assessing of lymphonodal metastases of cervical cancer. 15 patients with histologically proven cervical carcinoma were studied with 18F-FDG-PET regarding 18F-FDG-uptake of primary tumor and evidence as well as extent of lymphonodal metastases. 18F-FDG-PET and histopathological results were compared after radical hysterectomy with pelvic and supplementary in 7 cases paraaortal lymphadenectomy. All primary tumours showed 18F-FDG accumulation and had a mean maximal standardized uptake value (SUV) of 8.0 +/- 5.3. 3/6 lymph node metastases were obtained with 18F-FDG-PET. Micrometastases (size of metastasis < or = 0.2 cm) were present in 2 patients with false negative PET results. Regarding the subgroup with paraaortal lymph node dissection, PET detected one patient with metastases, the other one had micrometastasis, while metastasis was not observed by PET. The accuracy of PET is 73% for assessment of pelvic lymph nodes and 86% for assessment of paraaortal lymph nodes. In conclusion 18F-FDG accumulates reliably in primaries of cervical cancer. Regarding assessment of lymph node metastases PET seems to be of potential use, offering metabolic information independent of the size of metastatic lymph nodes. An improvement of accuracy can be expected if combined evaluation of morphologic and metabolic images is performed.

Adult↗
PubMed2001

[Phase specific technical aids prescription in neurological rehabilitation].

OBJECTIVE: The purpose of this study was to gain a phase specific survey concerning amount, types and costs of technical aids (TA) in a German neurological rehabilitation centre. Further, a number of common rehabilitation outcome parameters were to be related to technical aids provision. DESIGN: A prospective study included all patients (N = 509) with stroke, traumatic brain injury (TBI), brain tumour and multiple sclerosis (MS) admitted within a two-year period to the Klinik Berlin. The TAs prescribed were registered separately for each phase concerning type, amount and costs. In all, 108 different technical aids were recorded, and the direct costs for these technical aids were calculated. Outcome parameters used were the Barthel Index (BI) at admission and discharge, length of stay, and discharge destination. RESULTS: The mean (median) length of stay in phase B (C) was 76 (56) days with a mean (median) increase of BI score of 25 (15) points. Patients in phase D staid 35 days (median) at the clinic, their BI had been 100 points (median) already on admission. 93,3 % of all patients returned home (phase B and C 78,2 %). On average, patients in phase B and C received 2 technical aids/person, in phase D the median was 0 technical aid/person. On discharge, patients in phase B had an average of 3 technical aids/person, phase C patients had 4,5 TA/person and phase D patients 1 technical aid/person (median). The mean cost of a technical aid was 670 DM in phase B, 405 DM in phase C, and 290 DM in phase D (median). CONCLUSION: Technical aids are important components in rehabilitation, especially for severely affected patients, who receive the most expensive technical aids such as wheelchairs and bath tub lifters. High competence in questions related to technical aids is absolutely indispensable for any unit dealing with these patients. On the other hand, less affected patients mostly receive walking aids and grab bars. Future studies should deal with utilization rates and satisfaction with technical aids at home, as well as with cost-effectiveness issues.

Aged↗
PubMed2001

Prospective value of perfusion and X-ray attenuation imaging with single-photon emission and transmission computed tomography in acute cerebral ischemia.

BACKGROUND AND PURPOSE: The aim of the present study was to test the hypothesis that perfusion single-photon emission computed tomography (SPECT), carried out in addition to transmission computed tomography (TCT), improves the predictive value of brain imaging within the therapeutically relevant time window after acute cerebral ischemia. METHODS: Using TCT and [(99m)Tc]ethyl cysteinate dimer (ECD)-SPECT within 6 hours after symptom onset, we examined 108 patients (44 women, 64 men; mean age 65+/-13 years) with acute ischemic stroke attributed to the territory of the middle cerebral artery (MCA). In each case, 3 experts prospectively evaluated the early SPECT and TCT images. We correlated these ratings with follow-up TCT findings for the final infarction as well as with clinical outcome (Scandinavian Stroke Scale, Barthel Index, Modified Rankin Scale) after 30 and 90 days. RESULTS: Severe activity deficits on SPECT, not caused by local atrophy on TCT, were the best predictors (positive predictive value [PPV ]94%, 95% CI 89% to 99%; negative predictive value [NPV] 90%, 95% CI 78% to 100%; P<0.001) for evolving cerebral infarction. Complete MCA infarctions were predicted with significantly higher accuracy with early SPECT (area under receiver operating characteristic curve [AUC] index 0.91) compared with early TCT (AUC index 0.77) and clinical parameters (AUC index 0.73, P<0.05). Logistic regression analysis revealed 1 independent predictor for completed MCA territory infarction: SPECT activity deficits in the corresponding areas (PPV 88%, 95% CI 65% to 100%; NPV 96%, 95% CI 92% to 100%; P<0.001). Furthermore, death after stroke was optimally predicted by [(99m)Tc]ECD-SPECT. Clinical outcome up to 90 days after the stroke event best correlated with the degree of activity deficits in early SPECT (r=0.53, P<0.001). CONCLUSIONS: [(99m)Tc]ECD brain perfusion SPECT that completes TCT definitely improves the predictive value of brain imaging after acute cerebral ischemia. Thus, the combined imaging of brain edema and of cerebral perfusion early after stroke is recommended for clinical use.

Acute Disease↗
PubMed2001

An electromechanical gait trainer for restoration of gait in hemiparetic stroke patients: preliminary results.

Modern concepts of gait rehabilitation after stroke favor a task-specific repetitive approach. In practice, the required physical effort of the therapists limits the realization of this approach. Therefore, a mechanized gait trainer enabling nonambulatory patients to have the repetitive practice of a gait-like movement without overstraining therapists was constructed. This preliminary study investigated whether an additional 4-week daily therapy on the gait trainer could improve gait ability in 14 chronic wheelchair-bound hemiparetic subjects. The 4 weeks of physiotherapy and gait-trainer therapy resulted in a relevant improvement of gait ability in all subjects. Velocity, cadence, and stride length improved significantly (p < 0.01). The kinesiologic electromyogram of selected lower-limb muscles revealed a more physiologic pattern. The confounding influence of spontaneous recovery, the lack of a control group, and the double amount of therapy limit the clinical relevance of this study. Nevertheless, the gait trainer seems feasible as an adjunctive tool in gait rehabilitation after stroke; further studies are needed.

Adult↗
PubMed2001

Botulinum toxin A treatment of adult upper and lower limb spasticity.

This article discusses the treatment of spasticity with botulinum toxin A as a new approach in the neurological rehabilitation of patients after stroke. Clinical studies have been reviewed to provide information about target groups, technical aspects and the advantages and disadvantages of treating spasticity with botulinum toxin A. Open and controlled studies showed that the intramuscular injection of Dysport 500 to 1,500U or Botox 100 to 300U could reversibly relieve upper limb flexor and lower limb extensor spasticity. A reduced muscle tone, pain relief, better hand hygiene and improved walking function were the main benefits. Patients tolerated the treatment well. Activity or, if not possible, electrical stimulation of the injected muscles may enhance the effectiveness of the costly toxin. Serial casting is another option. With respect to the action of botulinum toxin A, it is suggested that the effect of the toxin could be mediated by paresis of both the extrafusal and intrafusal muscle fibres, thereby altering the afferent discharge in the muscle.

Adult↗
PubMed2001

Locomotor therapy in neurorehabilitation.

Gait rehabilitation is a major aspect of neurological rehabilitation. This review is on locomotor therapy by treadmill stimulation with partial body weight support evolving as a very promising treatment concept over the last years. It enables severely affected patients the repetitive practice of complex gait cycles and thus follows modern aspects of motor learning favoring a task-specific approach. Several studies have shown its potential in patients after stroke, spinal cord injury, M. Parkinson and cerebral palsy. An electromechanical gait trainer relieving the strenuous effort of the therapists and controlling the trunk in a phase-dependent manner is a new alternative.

Adult↗
PubMed2000

Treadmill training with partial body weight support in nonambulatory patients with cerebral palsy.

OBJECTIVE: To examine the potential role of treadmill training with partial body weight support in nonambulatory children with cerebral palsy. STUDY DESIGN: Open, nonrandomized, baseline-treatment study. SETTING: An outpatient rehabilitation clinic. SUBJECTS: Ten children with cerebral palsy. Six children (group A) were nonambulatory, and four children (group B) either required continuous physical help (two cases) or were able to walk short distances with a stand-by or independently (one case each). INTERVENTION: Three months of additional treadmill training, three times a week, 25 minutes a session. MAIN OUTCOME MEASURES: Functional Ambulation Categories, standing and walking section of the Gross Motor Function Measure, assessed at two baseline measurements 6 and 3 weeks before the study onset, at the beginning, and at the end of therapy. RESULTS: Measurements during baseline and at the study onset did not differ. During therapy, the mean Functional Ambulation Category improved significantly from 1.1 to 1.9 (p<.05). The sum score of the standing section of the Gross Motor Function Measure increased by 47% (p<.05). The walking section score increased by 50% (p<.01). Of the six nonambulant children in group A, transfer abilities improved in four, one child could walk short distances independently, and two children could walk with continuous physical support after therapy. Of group B, one child could climb stairs independently, three children only needed verbal support while walking, and all subjects could then stand up arm-free after therapy. CONCLUSIONS: Treadmill training with partial body weight support is a promising treatment technique in nonambulatory children with cerebral palsy.

Adolescent↗
PubMed2000

Potential of rheopheresis for the treatment of acute ischemic stroke when initiated between 6 and 12 hours.

Improvement of hemorheology is one of the most important approaches in the treatment of acute ischemic stroke. We investigated the influence of extracorporal rheopheresis (ER) on cerebral blood flow in patients with acute ischemic stroke and evaluated its therapeutic effect. Thirty-three patients (rheopheresis group, 17; control group, 16; mean age 64 +/- 10 years) with acute ischemic stroke were included in our prospective randomized trial. The first treatment was started within 12 h after onset of symptoms, and treatment was repeated 3 times at an interval of 24 h. Hemorheological parameters were measured before and after each session. The cerebral blood flow was analyzed using 99mTc-ECD-SPECT. The functional and neurological outcomes were determined by follow-up investigations after 3 months. The hemorheological parameters were significantly different between the rheopheresis group (18% decrease of plasma viscosity, 55% decrease of red blood cell aggregation) and the control group (no decrease of both parameters). The single photon emission computed tomography (SPECT) analysis showed early reperfusion in 35% of the patients treated with rheopheresis and in 37% of the control group (NS). There were no differences in the neurological outcomes between the 2 groups. Extracorporal rheopheresis is practicable and safe. It rapidly and consistently improved the hemorheological parameters. Although this did not impact on cerebral perfusion or clinical outcome in patients with acute ischemic stroke in this report, we propose that ER deserves to be further evaluated by initiating the first treatment within 6 h post-insult.

Adolescent↗
PubMed2000

A mechanized gait trainer for restoring gait in nonambulatory subjects.

OBJECTIVE: To construct an advanced mechanized gait trainer to enable patients the repetitive practice of a gaitlike movement without overstraining therapists. DEVICE: Prototype gait trainer that simulates the phases of gait (by generating a ratio of 40% to 60% between swing and stance phases), supports the subjects according to their ability (lifts the foot during swing phase), and controls the center of mass in the vertical and horizontal directions. PATIENTS: Two nonambulatory, hemiparetic patients who regained their walking ability after 4 weeks of daily training on the gait trainer, a 55-year-old woman and a 62-year-old man, both of whom had a first-time ischemic stroke. INTERVENTION: Four weeks of training, five times a week, each session 20 minutes long. MAIN OUTCOME MEASURES: Functional ambulation category (FAC, levels 0-5) to assess gait ability and ground level walking velocity. Rivermead motor assessment score (RMAS, 0-13) to assess gross motor function. RESULTS: Patient 1: At the end of treatment, she was able to walk independently on level ground with use of a walking stick. Her walking velocity had improved from .29m/sec to .59m/sec. Her RMAS score increased from 4 to 10, meaning she could walk at least 40 meters outside, pick up objects from floor, and climb stairs independently. Patient 2: At end of 4-week training, he could walk independently on even surfaces (FAC level 4), using an ankle-foot orthosis and a walking stick. His walking velocity improved from .14m/sec to .63m/sec. His RMAS increased from 3 to 10. CONCLUSION: The gait trainer enabled severely affected patients the repetitive practice of a gaitlike movement. Future studies may elucidate its value in gait rehabilitation of nonambulatory subjects.

Equipment Design↗
PubMed2000

Gait with and without forearm crutches in patients with total hip arthroplasty.

There is considerable variation between centres in the use of forearm crutches in the rehabilitation of patients with total hip arthroplasty who are capable of full weight bearing. This study aimed to compare the gait of patients with total hip arthroplasty walking with and without crutches. The gait analysis in 19 patients included the assessment of kinematics, kinetics and the kinesiological electromyographic activity of lower limb and trunk muscles. With the forearm crutches patients walked with a reduced cadence, a longer stride length and more symmetrically (P < 0.05). The activity of the gluteus medius, vastus medialis and lateralis, and erector spinae muscles of the affected and of the vastus medialis muscle of the unaffected side decreased significantly (P < 0.05). Furthermore, seven subjects displayed an abnormal activation pattern of the affected hip abductor when walking with forearm crutches, characterized by a second burst during swing (n = 5) or a tonic pattern (n = 2). It is concluded that the use of forearm crutches resulted in a symmetrical gait pattern. The reduced activity of relevant pelvi-trochanteric muscles and the disturbed activation pattern of the affected hip abductor when walking with crutches might indicate that patients should walk unaided as soon as possible to provide a more efficient muscular training under dynamic conditions.

Aged↗