Biomedical subjects

Stefan Hesse

Publications and source records attributed to Stefan Hesse.

9 recordsLinked to original sources

PubMed2003

Robot-assisted arm trainer for the passive and active practice of bilateral forearm and wrist movements in hemiparetic subjects.

OBJECTIVE: To determine whether use of a robotic arm trainer for bilateral exercise in daily repetitive training for a 3-week period reduced spasticity and improved motor control in the arm of severely affected, chronic hemiparetic subjects. DESIGN: Before-after trial. SETTING: Community rehabilitation center in Germany. PARTICIPANTS: Consecutive sample of 12 chronic hemiparetic patients; minimum stroke interval 6 months; patients could maximally protract the affected shoulder, hold the extended arm, or slightly flex and extend the elbow. INTERVENTIONS: Additional daily therapy of 15 minutes with the arm trainer for 3 weeks; the 1 degree of freedom trainer enabled the bilateral passive and active practice of a forearm pronation and supination and wrist dorsiflexion and volarflexion; impedance control guaranteed a smooth movement. MAIN OUTCOME MEASURES: Patients' impressions, the Modified Ashworth Scale (MAS) score (range, 0-5) to assess spasticity, and the arm section of the Rivermead Motor Assessment (RMA) score (range, 0-15) to assess motor control were rated before therapy, after each 3-week interval, and at follow-up 3 months later. RESULTS: All patients had favorable impressions: the extremity felt more vivid, and 8 subjects noticed a reduction in spasticity, an ease of hand hygiene, and pain relief. The MAS score of the wrist and fingers joints decreased significantly (P<.0125) from a median of 3 (2-3) and 3 (3-4) to 2 (1-2) and 2.5 (2-3). The RMA score minimally increased in 5 cases without improvement in functional tasks. The median RMA score before therapy was 2.0 (1-2) and 2.0 (1-3.75) after therapy. There were no side effects. At follow-up, the effects had waned. CONCLUSIONS: The arm trainer made possible intensive bilateral elbow and wrist training of severely affected stroke patients. Future studies should address the treatment effect in subacute stroke patients and determine the optimum treatment intensity.

Adult↗

PubMed2003

Treadmill training with partial body-weight support after total hip arthroplasty: a randomized controlled trial.

OBJECTIVE: To compare treadmill training with partial body-weight support (TT-BWS) and conventional physical therapy (PT) in ambulatory patients with hip arthroplasty. DESIGN: Randomized controlled trial. SETTING: Rehabilitation center. PARTICIPANTS: Eighty patients with a fully loadable implant who could walk independently with crutches after unilateral total hip arthroplasty were randomized to receive either TT-BWS (treatment group) or conventional PT (controls), for 10 working days. INTERVENTIONS: Each patient received 45 minutes of individualized PT, either treadmill training plus PT in the experimental or PT alone in the control group. MAIN OUTCOME MEASURES: The Harris score, recorded by blind assessors, served as the primary outcome measure. Secondary outcome measures were the hip extension deficit, gait velocity, gait symmetry, affected hip abductor power; hip abductor amplitude of electromyographic activation; and the interval from surgery to abandoning crutches. RESULTS: At the end of training, the treatment group's Harris score was 13.6 points higher (P<.0001) than the control group's score. Further, hip extension deficit was 6.8 degrees less (P<.0001), gait symmetry was 10% greater (P=.001), affected hip abductor was stronger (Medical Research Council grades 4.24 vs 3.73; P<.0001), and the amplitude of gluteus medius activity was 41.5% greater (P=.001) than those measures for controls. Gait velocity did not differ in the 2 groups. These significant differences in favor of the treatment group persisted at 3 and 12 months. The treatment group abandoned crutches sooner than the control group (3 vs 8wk). In the treatment group, 39 patients finished treatment, 35 appeared at 3, and 26 at 12 months for follow-up. In the control group, the corresponding numbers were 40, 35, and 24 patients, respectively. CONCLUSION: TT-BWS is more effective than conventional PT at restoring symmetrical independent walking after hip replacement.

Aged↗

PubMed2003

Treadmill training with partial body weight support after stroke.

Treadmill therapy with partial BWS is a promising new approach to improve gait ability after stroke. This task-specific approach enables nonambulatory patients the repetitive practice of complex gait cycles instead of single-limb gait-preparatory maneuvers. Patients walk more symmetrically with less spasticity and better cardiovascular efficiency on the treadmill than with floor walking. Several controlled, clinical studies have shown the potential of treadmill training as a therapeutic intervention for nonambulatory patients with chronic stroke-related hemiplegia. Furthermore, controlled trials in acute stroke survivors have shown that treadmill training is as effective as other physiotherapy approaches that stress the repetitive practice of gait. Controlled multicenter trials comparing locomotor training with conventional therapy will be forthcoming. An electromechanical gait trainer that relieves the strenuous effort of the therapists and provides control of the trunk in a phase-dependent manner is a new technical alternative for gait training in severely impaired stroke patients.

Acute Disease↗

PubMed2003

Upper and lower extremity robotic devices for rehabilitation and for studying motor control.

PURPOSE OF REVIEW: The successful motor rehabilitation of stroke, traumatic brain-injured and spinal cord-injured patients requires an intensive and task-specific therapy approach. Budget constraints limit a hand-to-hand therapy approach, so that intelligent machines may offer a solution to promote motor recovery and obtain a better understanding of motor control. This new field of automated or robot-assisted motor rehabilitation has emerged since the 1990s. RECENT FINDINGS: This article will present clinically viable devices for upper and lower extremity rehabilitation. The MIT-Manus and the Mirror-Image Motion Enabler robot, which enable unrestricted unilateral or bilateral shoulder and elbow movement, consistently proved superior on the motor impairment level. The ARM guide, which assisted reaching in a straight-line trajectory, and the Bi-Manu-Track, which enabled the bilateral practice of a forearm and wrist movement, are currently being tested. For gait rehabilitation after stroke, the electromechanical gait trainer, GT I, has proved effective compared with treadmill training with body weight support. The Lokomat, consisting of a treadmill and a powered exoskeleton, lessened the therapeutic effort compared with manually assisted treadmill training in spinal cord-injured patients. Future developments will see more degrees of freedom, improved man-machine interaction and the implementation of virtual reality. SUMMARY: Technical possibilities are one aspect, but multi-centre trials and a consideration of the unsubstantiated fears among therapists of being replaced by machines will decide on the successful implementation of this most promising field to the benefit of patients.

Artificial Limbs↗

PubMed2003

No benefit from D-amphetamine when added to physiotherapy after stroke: a randomized, placebo-controlled study.

OBJECTIVE: To assess the effect of D-amphetamine on the recovery of activities of daily living and motor functions after stroke, DESIGN: Randomized, placebo-controlled study, SETTING: Inpatient rehabilitation centre, SUBJECTS: Twenty-four stroke survivors after a first ischaemic supratentorial stroke within six weeks before study onset, severely to moderately affected, with a Barthel Index (0-100) ranging from 25 to 50, no severe concomitant internal, neurological or psychiatric diseases, and participating in a comprehensive rehabilitation programme of 10-12 weeks, INTERVENTIONS: Ten sessions with 10 mg D-amphetamine (or placebo) every fourth day totalling 100 mg in a time period of 36 days combined with physical therapy according to the neurodevelopmental concept within 60 minutes after drug intake. MAIN OUTCOME MEASURES: Barthel Index (0-100) served as the primary outcome measure and the Rivermead Motor Assessment Score with its three sections (gross function, leg and trunk, and arm) as the secondary outcome measure, assessed at days 0, 20, 36, 90, 180 and 360. RESULTS: The two groups did not differ with respect to clinical data and outcome measures at study onset. All patients improved significantly except for arm function over the intervention period and up to day 90 after study onset. The comparison between groups did not reveal any difference at any time; amphetamine-treated patients did not show any increase in motor function or ADL compared with the control group. CONCLUSIONS: The placebo-controlled study failed to show any effect of D-amphetamine on stroke recovery compared with control. The small number of patients, the timing and content of physical therapy were limiting factors of the present study. Further trials are warranted.

Activities of Daily Living↗

PubMed2003

Poststroke motor dysfunction and spasticity: novel pharmacological and physical treatment strategies.

Following stroke, approximately 90% of patients experience persistent neurological motor deficits that lead to disability and handicap. Both pharmacological and physical treatment strategies for motor rehabilitation may be considered. In terms of pharmacological treatment, drugs that may potentially promote motor recovery when added to a regimen of physical therapy include the stimulants amphetamine and methylphenidate, as well as levodopa and fluoxetine. Botulinum toxin A has proven effective and well tolerated in several placebo-controlled trials for the treatment of focal upper and lower limb spasticity, although it has not been shown to improve motor function. The focal injection of botulinum toxin A inhibits the release of acetylcholine into the synaptic cleft, resulting in a reversible paresis of the muscles relevant for the spastic deformity. Other drugs, such as benzodiazepines, antiepileptic drugs and antipsychotics, may have detrimental effects on motor function and should be avoided, if possible. With respect to physical strategies, modern concepts of motor learning favour a task-specific repetitive approach that induces skill-acquisition relevant to the patient's daily life. Constrained-induced movement therapy based on the concept of learned non-use, electromyography-triggered electrical stimulation of the wrist muscles, robot-assisted motor rehabilitation to increase therapy intensity and bilateral practice to facilitate the movement of the paretic extremity are examples in upper limb rehabilitation. Lower limb rehabilitation has been enriched by treadmill training with partial bodyweight support, enabling the practice of up to 1000 steps per session; automated gait rehabilitation to relieve the strenuous effort required of the therapist; and rhythmic auditory stimulation, applying individually adjusted music to improve walking speed and symmetry.

Animals↗

PubMed2003

Partial body weight supported treadmill training for gait recovery following stroke.

PBWSTT has emerged from an interesting idea to a well-accepted and scientifically supported treatment modality for gait training after stroke. PBWSTT offers a task-specific approach to functional gait retraining that is based on rehearsal of repetitive controlled gait cycles. Newer devices are being developed that will provide better mechanical control of the patient and reduce therapist effort.

Automation↗

PubMed2003

BalanceReTrainer: a new standing-balance training apparatus and methods applied to a chronic hemiparetic subject with a neglect syndrome.

In this paper we present a mechanical apparatus and methods named BalanceReTrainer for standing-balance training in neurologically impaired individuals. BalanceReTrainer provides an impaired individual with a fall-safe balancing environment, where the balancing efforts of a standing individual are augmented by stabilizing forces acting at the level of pelvis in the sagittal and frontal planes of motion, assisting the balancing activity ankle and hip muscles and at the level of shanks, assisting the knee extensor muscles. A range of different levels of supporting forces is generated by passive, compliant means. Additionally, movement in the sagittal and frontal planes, acquired by transducers is fed to an electronic interface which transforms the current inclinations into a computer mouse signals, which are interfaced to a personal computer (PC) where balance training and evaluation program is running. The level of stiffness support and level of difficulty of computer task can be selected according to current balancing abilities of the impaired individual. We further present results of a case study where an ambulatory chronic hemiparetic subject with neglect syndrome received ten days of balance training on BalanceReTrainer. Biomechanical evaluation of weight-shifting activity before and after treatment shows a substantial functional improvement.

Adult↗

PubMedDate not supplied

Machines to support motor rehabilitation after stroke: 10 years of experience in Berlin.

The group at Klinik Berlin/Charite University Hospital in Berlin, Germany, began studies to promote motor recovery after stroke in the early 1990s. Following the introduction of treadmill training with partial body-weight support, the group designed an electromechanical gait trainer, GT I, based on movable foot plates that relieve therapist effort (e.g., when assisting the movement of the paretic limbs) and intensify patient gait training (GT). Preliminary results of a recent multicenter trial of 155 acute stroke patients showed that the GT I effectively promotes gait ability and competence in activi ties of daily living. The experimental group received 20 min of GT and 25 min of physiotherapy (PT) and the control group received 45 min of PT every day for 4 weeks. The laboratory's next step was the HapticWalker, a robotic walking simulator with freely programmable foot plates so that patients can, for example, additionally train for stair climbing and perturbations. The foot plates can be operated in full guidance or compliance control modes, thus reducing foot support according to the patient's learning success. For the severely affected upper limb, the laboratory's computerized arm trainer, called the Bi-Manu-Track, enables bilateral practice of forearm pronation/supination and wrist flexion/extension. Compared with electrical stimulation of the paretic wrist extensors, acute stroke patients with severe arm paresis (n = 44) had significantly more upper-limb muscle strength and control at the end of the 6-week intervention period and at follow-up. The laboratory's most recent and cost-effective development, the Nudelholz, is a purely mechanical device that bilaterally trains the shoulder, elbow, and wrist joints. It is intended for home therapy.

Berlin↗