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Biomedical subjects

K H Mauritz

Publications and source records attributed to K H Mauritz.

At least 19 recordsLinked to original sources
PubMed2004

Gait training in hemiparetic stroke patients.

The major goal of neurological rehabilitation includes restoration of mobility. In mobility we include walking, standing up, sitting down, weight shifting from one leg to the other, turning around, initiating and stopping locomotion, as well as climbing stairs. The therapeutic procedures include: different concepts of physiotherapy stressing different features, like force exercise, reduction of spasticity, gait symmetry, utilization of equilibrium reflexes, stepping automation, endurance training, repetition of rhythmic movements etc. The spectrum of available therapies was recently widened by treadmill training with partial body-weight support, gait machines, by functional electrical stimulation (FES), locomotor pharmacotherapy, selective reduction of spasticity by botulinum-toxin (BTX) injections, acoustic and visual cuing and biofeedback. These methods pertaining to gait improvement will also be described. Technical aids should be prescribed earlier, since their costs are usually almost negligible if compared to the costs for a prolonged inpatient treatment. Treadmill training with partial body-weight support in a parachute harness allows early training of postural reactions and stepping. The gait pattern can be considerably improved by FES. A new approach includes mechanical and computer controlled training machines to enable the repetitive training of complex gait cycles without overstressing therapists. First results demonstrate positive effects beyond the classical retraining procedures.

Journal Article↗
PubMed2001

Arm ability training for stroke and traumatic brain injury patients with mild arm paresis: a single-blind, randomized, controlled trial.

OBJECTIVE: To test the efficacy of the arm ability training (AAT) on a sample of patients with central arm paresis after traumatic brain injury (TBI) or stroke. DESIGN: Single-blind, randomized, controlled trial. SETTING: Inpatient rehabilitation center. PATIENTS: Consecutive sample of 74 patients of whom 60 (45 with stroke, 15 with TBI) completed the study; 37 patients received a 1-year follow-up. INTERVENTION: Daily AAT with (n = 20) or without (n = 20) knowledge of results, or no AAT (n = 20) during a 3-week intervention period. MAIN OUTCOME MEASURES: Summary time scores of the Test Evaluant les Membres superieurs des Personnes Agees (TEMPA)-a test of upper extremity function with daily function-like activities (focal disability)-and kinematic analysis of aimed movements. RESULTS: Patients with AAT realized superior improvement as compared with controls. Mean improvement in the time needed to perform (1) all TEMPA tasks was 41.4 versus 12.8 seconds (p =.0012); (2) unilateral TEMPA tasks, 16.5 versus 4.2 seconds (p =.0036); and (3) the ballistic component of aimed movements, 96 versus 20ms (p =.0115). Knowledge of result did not substantially modify these effects. A functional benefit existed at 1-year follow-up. CONCLUSION: The AAT reduces focal disability among stroke and TBI patients with mild central arm paresis.

Activities of Daily Living↗
PubMed2000

Multimodal EEG analysis in man suggests impairment-specific changes in movement-related electric brain activity after stroke.

Movement-related slow cortical potentials and event-related desynchronization of alpha (alpha-ERD) and beta (beta-ERD) activity after self-paced voluntary triangular finger movements were studied in 13 ischaemic supratentorial stroke patients and 10 age-matched control subjects during movement preparation and actual performance. The stroke patients suffered from central arm paresis (n = 8), somatosensory deficits (n = 3) or ideomotor apraxia (n = 2). The multimodal EEG analysis suggested impairment-specific changes in the movement-related electrical activity of the brain. The readiness potential of paretic subjects was centred more anteriorly and laterally; during movement, they showed increased beta-ERD at left lateral frontal recording sites. Patients with somatosensory deficits showed reduced alpha-ERD and beta-ERD during both movement preparation and actual performance. Patients with ideomotor apraxia showed more lateralized frontal movement-related slow cortical potentials during both movement preparation and performance, and reduced left parietal beta-ERD during movement preparation. We conclude that (i) disturbed motor efference is associated with an increased need for excitatory drive of pyramidal cells in motor and premotor areas or an attempt to drive movements through projections from these areas to brainstem motor systems during movement preparation; (ii) an undisturbed somatosensory afference might contribute to the release of relevant cortical areas from their 'idling' state when movements are prepared and performed; and (iii) apraxic patients have a relative lack of activity of the mesial frontal motor system and the left parietal cortex, which is believed to be part of a network subserving ideomotor praxis.

Adult↗
PubMed1999

Testing a motor performance series and a kinematic motion analysis as measures of performance in high-functioning stroke patients: reliability, validity, and responsiveness to therapeutic intervention.

OBJECTIVE: To assess measurement properties of motor performance tests when used with high-functioning stroke patients. DESIGN: Test-retest reliability study with an interval of 2 days; responsiveness study with assessment before and after training; validity study assessing the tests' ability to discriminate between the high-functioning stroke patients and healthy subjects. SETTING: Referral center for neurorehabilitation. PARTICIPANTS: Twenty-nine high motor-functioning stroke patients and 20 healthy control subjects. INTERVENTION: Two special training sessions per day on 5 consecutive days, plus regular therapy. OUTCOME MEASURES: Scores on the motor performance series, a two-dimensional tracking test, and a kinematic task analysis. RESULTS: All tests (except the bimanual test) were able to document performance deficits with these patients and showed a moderately high to high test-retest reliability without systematic trend from test to retest (intraclass correlation coefficients for main variables, .61 to .89). The kinematic task especially demonstrated changes after training (standardized response means for timing variables, .53 to .66). A subset of variables indicated a modifying effect of limb side, age, and gender. CONCLUSION: All tests (except the bimanual test) can be used for both cross-sectional and follow-up group studies with high-functioning stroke patients. Measurement properties and the lack of comprehensive normative data limit their use with individual patients.

Adult↗
PubMed1998

[Value of functional electrostimulation in patients with paraplegia].

This 1-year follow-up study included 17 patients with spinal cord injuries who participated in a functional electrical stimulation (FES) program for restoration of the ability to stand and walk. Four tetraplegic patients reached a mean FES-assisted standing duration of 6.8 min after 6 weeks. After 1 year three patients had stopped FES-assisted standing due to orthostatic problems and only used the system for cyclic stimulation of quadriceps muscles while lying down. Ten paraplegic patients had a mean standing duration of 22.6 min. The gait velocity (gait distance) of seven patients ranged from 2.9 to 24.2 m/min (from 4 to 335 m) in seven patients. Due to flexor spasm in two and unrealistic expectations in seven cases, four patients stopped the program and five only practiced FES-assisted standing. One patient continued FES walking after 1 year. Three patients with an incomplete cervical lesion who had been able to walk a short distance before treatment achieved constant improvement their gait ability. Their gait velocity/walking distance without FES improved for a mean of +33.3%/+163.8%, after 6 weeks. Assuming that FES is used according to the level of impairment, the results favor broader application of the method in the rehabilitation of patients with spinal cord injuries.

Adult↗
PubMed1997

Asymmetry of gait initiation in hemiparetic stroke subjects.

OBJECTIVE: To investigate symmetry of gait initiation in healthy and hemiparetic subjects. DESIGN: Survey. SETTING: Kinematic laboratory affiliated with a hospital-based department of rehabilitation. PATIENTS OR OTHER PARTICIPANTS: Ten healthy and 14 hemiparetic stroke subjects starting five times with their right and left leg, respectively. MAIN OUTCOME MEASURES: Duration of defined periods, step length, center of pressure, and center of mass were recorded and calculated using two triaxial force plates, contact switches, and a video camera system. RESULTS: Healthy subjects displayed a high degree of independence of kinetic and kinematic parameters of the starting limb. Hemiparetic patients showed differences with respect to the starting limb: when starting with the nonaffected leg, the swing period and step length was shorter and the center of pressure displayed a more marked medio-lateral sway with no corresponding initial movement of the center of mass; when starting with the affected leg the movement pattern of the center of pressure and center of mass was comparable to that of normal subjects. CONCLUSIONS: The trajectories of the center of pressure and center of mass and the symmetry parameters are in accordance with a higher degree of uncertainty when starting with the non-affected limb in hemiparetic subjects.

Aged↗
PubMed1997

The Arm Motor Ability Test: reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living.

OBJECTIVE: To continue and expand determination of the reliability, validity, and sensitivity to change of the Arm Motor Ability Test (AMAT), an instrument for assessing deficits in activities of daily living (ADL). DESIGN: The AMAT was administered twice to patients, with an interest interval of either 1 or 2 weeks, by one of two examiners assigned to patients in counterbalanced order. Patients' interest intervals and scores on the arm portion of the Motricity Index was unknown to the raters. SETTING: A referral inpatient neurological rehabilitation center. PATIENTS: Thirty-three subacute stroke inpatients with moderate to mild upper extremity motor deficit: median Motricity-Index-Arm score = 89, median chronicity = 43d, median age = 66yr; 12 were women. MAIN OUTCOME MEASURE AND RESULTS: The AMAT was developed in 1987, and interrater reliabilities at that time were found to range from .95 to .99. The present values for interrater reliability (2 scales) from videotaped test performance were: kappas = .68 to .77. Spearman correlations = .97 to .99. For performance time, interscorer reliability from videotaped test performance was .99. Homogeneities for the three AMAT measures for the total sample (Cronbach's alpha and split-half reliability) were .93 to .99. The test-retest reliabilities for the total sample were .93 to .99. The correlations to the Motricity-Index-Arm score were .45 to .61. The AMAT detected the difference in change occurring as a result of the passage of 1 versus 2 weeks in these subacute inpatients, presumably as a result of intensive therapy and/or spontaneous recovery, confirming the results of an earlier intervention study. CONCLUSION: The AMAT is an instrument with high interrater reliability, internal consistency, and sensitivity to change, as well as having satisfactory concurrent validity.

Activities of Daily Living↗
PubMed1997

Management of spasticity.

Recent open studies and two placebo-controlled studies confirm the potential role of Botulinum toxin A in the treatment of focal spasticity in adults and children. The effect of the toxin might not only be mediated by the paresis of extrafusal, but also intrafusal muscle fibres, thereby altering the afferent discharge. To enhance its effectiveness, an additional electrical stimulation seems promising. Most patients tolerate the neurolytic agent well. Two individuals, however, suffered from an intermittent tetraparesis after treatment. The repetitive magnetic stimulation and the use of gabapentin might be other new therapeutic options in the management of spasticity.

Adult↗
PubMed1996

Gait function in spastic hemiparetic patients walking barefoot, with firm shoes, and with ankle-foot orthosis.

The purpose of the study was to investigate the effect of firm shoes and a particular type of a frequently prescribed ankle-foot orthosis in Germany, the Valens calliper, on functional gait parameters in hemiparetic patients with marked extensor spasticity and corresponding heel-strike problems. Cycle times, vertical ground reaction forces, trajectories of the centre of pressure (gait line) under the soles and the mode of initial contact were assessed in 19 hemiparetic patients walking barefoot, with firm shoes and the orthosis. With the shoes, significant improvements (p < 0.006) were observed for: walking velocity, stride length, initial double stance duration and gait line of the non-affected foot. The pattern of the vertical force diagram improved qualitatively in six patients. With the orthosis the following variables showed an even more marked improvement (p < 0.006): walking velocity, cadence, stride length, and gait line of both the affected and non-affected foot. Fourteen patients became rear-foot strikers and the vertical force pattern further improved in six patients. It is concluded that the ankle-foot orthosis (more than the shoes) provide a useful support in the early rehabilitation of hemiparetic patients with marked spasticity.

Adult↗
PubMed1996

Ankle muscle activity before and after botulinum toxin therapy for lower limb extensor spasticity in chronic hemiparetic patients.

BACKGROUND AND PURPOSE: Recent studies have been made of the novel treatment of lower limb spasticity after stroke with botulinum toxin A, and the results were based mostly on the clinical assessment made before and after treatment. This study investigated the effects of toxin on ankle muscle activity during gait in patients with severe extensor spasticity. The questions posed were whether the toxin particularly diminishes the so-called premature muscle activity as a major cause of equinovarus deformity and whether different types of altered motor control allow a prediction of the outcome of the treatment. METHODS: In 12 chronic hemiparetic outpatients with pronounced lower limb spasticity, we injected 400 U botulinum toxin A into the soleus and tibialis posterior muscles and both heads of the gastrocnemius muscles. Ankle spasticity and complex gait analysis including kinematic electromyography (EMG) of the soleus and tibialis muscles were assessed before treatment and 4 weeks after the injection. RESULTS: Nine patients profited with a reduction of spasticity, improved gait ability, and a more normal temporal pattern of muscle activity with a prominent reduction of the premature activity of the plantar flexors. Eight patients exhibited a qualitative pattern (type I) corresponding to an increased stretch-reflex excitability. Three patients did not profit; their muscle tone, gait ability, and muscle activation remained stable or even deteriorated. CONCLUSIONS: This study further supports the beneficial effects of botulinum toxin in the treatment of lower limb extensor spasticity. A correlation was observed between the clinical reduction of muscle tone, functional gait parameters, and a more normal EMG pattern with a predominant reduction of the premature activity of the plantar flexors. The qualitative type of EMG pattern corresponding to an increased stretch-reflex excitability (type I) was a positive predictor for the outcome.

Adult↗
PubMed1996

[Effect of music on gait symmetry of stroke patients on a treadmill].

The influence of rhythmic music on gait symmetry was investigated in 12 healthy subjects and 12 stroke patients with mild leg paresis walking on the treadmill. For the measurement, new insoles containing air-filled chambers developed by W.O.M were used. Symmetry deviation was determined as the mean signless difference between left and right swing phases of some 100 strides. In 6 patients, the symmetry deviation decreased by more than 1% of the stride duration some 40 steps after switching on the music. The improvement correlated with the initial symmetry (r2 = 0.61) exclusively in the healthy controls. In order to differentiate individual predictors of the improvement in symmetry, such as cognitive performance in terms of recognizing the beat of the music and the motor performance in terms of synchronizing the movements of the legs to the music, we analysed foot tapping with the patient in the seated position. For both patients and healthy subjects, the mean time difference between beat and foot movement was less than +/-1/32 beat. Individual scatter of mean 8% correspond in the case of healthy subjects to the figures found in the literature for finger movements, and the corresponding figures for the patients are more than twice this. The individual synchronisation performance during walking to music correlates to that during foot tapping (r2 = 0.47) exclusively in the group of healthy controls.

Cerebrovascular Disorders↗
PubMed1995

Short-term electrical stimulation enhances the effectiveness of Botulinum toxin in the treatment of lower limb spasticity in hemiparetic patients.

The study tested the spasmolytic effect of Botulinum toxin A in two groups of hemiparetic patients with lower limb spasticity: in the first group (n = 5) 2000 U Dysport were injected into the soleus, tibialis posterior and both heads of gastrocnemius muscles alone; the second (n = 5) received additional repetitive alternating electrical stimulation of M. tibialis anterior and plantar flexors for 30 min six times per day during the 3 days following the injection. Muscle tone, rated by the Ashworth spasticity score, and gait analysis including recording of vertical ground reaction forces, were assessed before and 4 weeks after injection. The combined treatment proved to be more effective with respect to the clinically assessed reduction of muscle tone, gait velocity, stride length, stance- and swing-symmetry (P < 0.05). The result is discussed with reference to animal experiments demonstrating enhanced toxin uptake and accelerated onset of its paralytic effect by electrical stimulation.

Adult↗
PubMed1995

Human motor planning, motor programming, and use of new task-relevant information with different apraxic syndromes.

Patients with ideomotor apraxia (n = 2) or ideational apraxia (n = 2) after left brain stroke and patients with constructional apraxia (n = 2) after cerebrovascular accident of the right hemisphere, as well as 16 non-brain-damaged control subjects, were given a standardized simple motor task: they were asked to make triangular arm movements of specific size, configuration and spatial orientation without visual control. Motion was analysed three-dimensionally in great detail prior to and after kinaesthetic training using a triangular stencil, and 1 day later. The experiment was conceptualized to assess three aspects of motor behaviour: (i) motor planning, operationalized as specification of content parameters of the movement as a whole; (ii) motor programming, the specification of spatiotemporal parameters of movement segments; and (iii) the ability to make use of task-relevant information provided by the training. Patients with ideational apraxia showed signs of impaired motor planning: they had difficulty in selecting the body parts to be moved, and movement concept and configurational aspects were deficient. The kinaesthetic sensorimotor training given seemed not adequate to reduce behavioural deficits. Kinematic peculiarities of patients with ideomotor apraxia can be understood as deficits in programming movement elements. Submovements were more segmented, showed irregularities as well as additional, not-requested elements. Their impairments could be reduced by task-specific sensorimotor training. Patients suffering from visuoconstructive apraxia after right brain damage might have difficulties in making use of new sensorimotor information relevant for spatial-motor aspects, as suggested by training-induced behavioural impairment with a severely constructional apraxic patient.

Aged↗
PubMed1995

Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand.

The effect of a standardized training on movements of the affected hand has been studied in 27 hemiparetic patients using a multiple baseline approach across individuals. The training consisted of repetitive hand and finger flexions and extensions against various loads and was carried out twice daily during 15-min periods. Grip strength (p < 0.006), peak force of isometric hand extensions (p < 0.05), peak acceleration (p < 0.05) of isotonic hand extensions as well as contraction velocities as indicators of motor performance significantly improved during the training period. In contrast to the standardized training of hand and finger movements, therapeutic strategies following the Bobath concept aim at reducing enhanced muscle tone without reinforcing the activity in centrally paretic distal muscle groups directly. Patients undergoing this treatment approach alone did not experience a significant improvement in the motor capacity of the hand. Therefore, the results of the present study emphasize the importance of frequent movement repetition for the motor rehabilitation of the centrally paretic hand and challenge conventional physiotherapeutic strategies that focus on spasticity reduction instead of early initiation of active movements.

Adult↗
PubMed1995

Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients.

BACKGROUND AND PURPOSE: Treadmill training with partial body weight support is a new and promising therapy in gait rehabilitation of stroke patients. The study intended to investigate its efficiency compared with gait training within regular physiotherapy in nonambulatory patients with chronic hemiparesis. METHODS: An A-B-A single-case study design compared treadmill training plus partial body weight support (A) with physiotherapy based on the Bobath concept (B) in seven nonambulatory hemiparetic patients. The minimum poststroke interval was 3 months, and each treatment phase lasted 3 weeks. Variables were gait ability assessed by the Functional Ambulation Category, other motor functions tested by the Rivermead Motor Assessment, muscle strength assessed by the Motricity Index, muscle tone rated by the Modified Ashworth Spasticity Scale, and gait cycle parameters. RESULTS: Treadmill training was more effective with regard to restoration of gait ability (P < .05) and walking velocity (P < .05). Other motor functions improved steadily during the study. Muscle strength did not change, and muscle tone varied in an unsystematic way. The ratio of cadence to stride length did not alter significantly. CONCLUSIONS: Treadmill training offers the advantages of task-oriented training with numerous repetitions of a supervised gait pattern. It proved powerful in gait restoration of nonambulatory patients with chronic hemiparesis. Treadmill training could therefore become an adjunctive tool to regain walking ability in a shorter period of time.

Aged↗
PubMed1995

Restoration of gait by combined treadmill training and multichannel electrical stimulation in non-ambulatory hemiparetic patients.

Functional electrical stimulation and treadmill training with partial body weight support through suspension by a parachute harness were combined for gait restoration in 11 chronic non-ambulatory hemiparetic patients. Individually adjusted multichannel stimulation of the trunk and of upper and lower limb muscles, as well as a motor driven treadmill, induced functional gait within 3 to 6 weeks. The improvement of gait ability was assessed by the Functional Ambulation Category test. Other motor functions were rated by the Rivermead Motor Score. The leg muscle strength, stride length, cadence, gait velocity and gait pattern were recorded. In seven of the patients, we did a single case research A-B-A study that showed that this combined approach had advantages, in regard to gait restoration and walking velocity (p <0.05) as compared with our common physiotherapeutic programme.

Adult↗
PubMed1994

Restoration of gait in nonambulatory hemiparetic patients by treadmill training with partial body-weight support.

The effect of a treadmill training with partial body-weight support was investigated in nine nonambulatory hemiparetic patients with a mean poststroke interval of 129 days. They had received regular physiotherapy within a comprehensive stroke rehabilitation program at least 3 weeks before the treadmill training without marked improvement of their gait ability. After 25 additional treadmill training sessions scoring of functional performance and conventional gait analysis showed a definite improvement: gait ability, assessed by the Functional Ambulation Category (0 to 5) improved with a mean of 2.2 points, other motor functions, assessed by the Rivermead Motor Assessment Score with a mean of +3.9 points for gross function (range 0 to 13) and of +3.2 points for leg and trunk section (range 0 to 10)] and gait cycle parameters (p < .01). Muscle tone and strength of the paretic lower limb remained stable. We suggest that treadmill training with partial body-weight support could augment restoration of ambulation and other motor functions in hemiparetic patients by active and repetitive training.

Adult↗