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T Platz

Publications and source records attributed to T Platz.

At least 19 recordsLinked to original sources
PubMed2005

Impairment-oriented training and adaptive motor cortex reorganisation after stroke: a fTMS study.

In a sample of 28 subacute anterior circulation ischemic stroke patients with severe arm paresis, reduced motor cortex excitability (increased motor thresholds, reduced MEP amplitudes, reduced number of active points) and a reduced conduction velocity in the corticospinal system were found in the affected hemisphere. At the same time motor cortex topology for the abductor pollicis brevis (APB) representation was comparable for the affected and non-affected hemisphere. Considerable arm motor recovery (Fugl-Meyer test) was observed when assessed four weeks later after a period of rehabilitation intervention. Motor cortex excitability and conduction velocity in the corticospinal system improved in the affected hemisphere. In addition, APB representation showed a medial shift in patients with such a representation at pre test (n=14). Multiple stepwise regression indicated that of all transcranial magnetic stimulation (TMS) parameters only the medial shift of the motor cortex map predicted motor recovery. Assessing the effect of training time (non-intensified vs. intensified therapy) and type of arm training (Bobath approach vs. Arm BASIS training) with a randomised controlled design revealed that the impairment-oriented Arm BASIS training improved motor control more than the control conditions. In addition, patients of the group receiving the Arm BASIS training with an APB representation at pre test showed a medial shift of the motor cortex map and improved conduction times. In conclusion, changes in motor cortex topology were likely to be relevant for motor recovery and might have been induced by the impairment-oriented training.

Aged↗
PubMed2005

[Apraxia--neuroscience and clinical aspects. A literature synthesis].

Apraxic phenomena occur in various neurological conditions. Selective motion control is viewed as the basic capacity to make fine and precise, isolated or independent face or limb movements. Its deficit can indicate limb-kinetic apraxia if it is not explained by paresis, somatosensory deafferentation, or ataxia. The core deficit in ideomotor apraxia could be deficient movement representations, i.e. the combination of invariant features of intrinsic and extrinsic coding for a given movement, which are most important when movements have to be performed outside their typical context. Ideational apraxia would be defined by a semantic deficit related to action. Frontal apraxia is characterised by an action-sequencing deficit. A detailed model is proposed regarding processes relevant to praxis.

Apraxias↗
PubMed2005

Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: a single-blind, multicentre randomized controlled trial.

OBJECTIVE: To study the effects of augmented exercise therapy time for arm rehabilitation as either Bobath therapy or the impairment-oriented training (Arm BASIS training) in stroke patients with arm severe paresis. DESIGN: Single blind, multicentre randomized control trial. SETTING: Three inpatient neurorehabilitation centres. SUBJECTS: Sixty-two anterior circulation ischaemic stroke patients. INTERVENTIONS: Random assignment to three group: (A) no augmented exercise therapy time, (B) augmented exercise therapy time as Bobath therapy and (C) augmented exercise therapy time as Arm BASIS training. MAIN MEASURES MAIN OUTCOME MEASURE: Fugl-Meyer arm motor score. Secondary measure: Action Research Arm Test (ARA). Ancillary measures: Fugl-Meyer arm sensation and joint motion/pain scores and the Ashworth Scale (elbow flexors). RESULTS: An overall effect of augmented exercise therapy time on Fugl-Meyer scores after four weeks was not corroborated (mean and 95% confidence interval (CI) of change scores: no augmented exercise therapy time (n=20) 8.8, 5.2-12.3; augmented exercise therapy time (n=40) 9.9, 6.8-13.9; p = 0.2657). The group who received the augmented exercise therapy time as Arm BASIS training (n=20) had, however, higher gains than the group receiving the augmented exercise therapy time as Bobath therapy (n=20) (mean and 95% CI of change scores: Bobath 7.2, 2.6-11.8; BASIS 12.6, 8.4-16.8; p = 0.0432). Passive joint motion/pain deteriorated less in the group who received BASIS training (mean and 95% CI of change scores: Bobath -3.2, -5.2 to -1.1; BASIS 0.1, -1.8-2.0; p = 0.0090). ARA, Fugl-Meyer arm sensation, and Ashworth Scale scores were not differentially affected. CONCLUSIONS: The augmented exercise therapy time as Arm BASIS training enhanced selective motor control. Type of training was more relevant for recovery of motor control than therapeutic time spent.

Arm↗
PubMed2005

Amphetamine fails to facilitate motor performance and to enhance motor recovery among stroke patients with mild arm paresis: interim analysis and termination of a double blind, randomised, placebo-controlled trial.

PURPOSE: To assess the effects of d-amphetamine on motor facilitation and recovery in stroke patients with mild arm paresis receiving the Arm Ability training. METHODS: Thirty-one stroke patients with mild arm paresis were randomly assigned to either (a.) receiving placebo or (b.) d-amphetamine twice a week 2 hours before Arm Ability training sessions for three weeks. MAIN OUTCOME MEASURE: time needed to perform TEMPA tasks, a measure of upper extremity performance reflecting everyday life tasks. Secondary measures: aimed movements, tapping, and a 10 m walkway as well as motor performance during training sessions. RESULTS: The interim efficacy analysis of 26 stroke patients who completed the study intervention showed overall arm motor recovery both from pre to post test after 3 weeks of training and from pre test to follow-up 1 year later. No superior effect of d-amphetamine over placebo could be substantiated for either motor facilitation during training or motor recovery (post training or long-term). D-amphetamine exerted mild effects on blood pressure. Serious adverse events were not observed. CONCLUSIONS: d-Amphetamine failed to facilitate motor performance during training sessions, to promote skill acquisition with training tasks, and most importantly to enhance motor recovery among patients with mild arm paresis after stroke.

Aged↗
PubMed2004

Impairment-oriented training (IOT)--scientific concept and evidence-based treatment strategies.

Everyday activities can be affected by many different body dysfunctions (impairments). A multi-modal analysis of electric brain activity revealed that movement-related brain activity is differentially altered in patients with different impairments, i.e. paresis, somatosensory deficits, and apraxia. Each body dysfunction has its own characteristics in terms of the resulting sensorimotor control deficits. The Impairment-oriented Training concept intends to characterise the resulting sensorimotor control deficits for each impairment. Based on such analyses two specific training techniques have been developed for stroke patients with mild and severe arm paresis: (1.) The Arm Ability training for mild arm paresis trains different sensorimotor abilities such as dexterity, speed of isolated hand and finger movements, steadiness, aiming, or tracking under visual guidance. Improvement of these motor abilities leads to improved motor performance in every day life circumstances. (2.) The Arm BASI S training for severe arm paresis intends to restore more basic motor control, i.e. the full range of active non-segmented motion of all limb segments, both postural activities and dynamic motion control, interjoint-coordination, and adequate motor control when external forces are applied. Clinical trials with representative study populations supported both techniques' clinical efficacy.

Arm↗
PubMed2003

[Evidence-based arm rehabilitation--a systematic review of the literature].

Based on a systematic MEDLINE search and informal sources, 40 references were identified that evaluate training therapy or neuromuscular electric stimulation for arm paresis after stroke and describe either a systematic review, meta-analysis, randomised controlled trial, or controlled cohort study. The evidence was grouped into three areas of interest: comparison of physiotherapy schools, effects of intensity of training, and efficacy of specific arm rehabilitation techniques. The only physiotherapy school with evidence of superior efficacy was the task-oriented 'motor relearning programme'. Higher intensities of motor rehabilitation can accelerate motor recovery. Various training techniques with demonstrated efficacy are available for specific patient subgroups: arm ability training for mildly affected patients with reduced efficiency of motor control, constrained-induced movement therapy for patients with partial functional deficits and learned nonuse of the affected arm, and repetitive sensorimotor training techniques, EMG-biofeedback, functional electrical stimulation, and robot-assisted training for patients with severe arm paresis.

Arm↗
PubMed2002

[Results of a poll of cancer patients with respect to pain and quality of life].

AIM: Bernatzky et al. recently published a study on the prescribing practices of general practitioners in Austria with respect to the prescribing of opioids in cancer patients. The aim of the study was to assess the adequately of pain therapy and the resulting quality of life in chronic cancer patients. METHODS: A representative sample of patients was taken from the Carinthian tumor register. These patient were sent a questionnaire alone with an explanatory letter and at a later date a reminder letter by mail. RESULTS: Of the 1.895 returned questionnaires 665 (35%) were completed. In this study only the data of the 429 patients who indicated that they experienced pain were processed. More than one fifth of the patients complained of a poor or a very poor quality of life and 80% of the patients were limited in their activities of daily living by pain. There are still many prejudices and informational gaps with respect to the effects of morphine. The main focus of treatment was medication therapy and was generally carried out by the family physician. The satisfaction with pain therapy was at best moderate. This is insofar of importance, as the satisfaction with pain therapy has a massive impact on the quality of life. CONCLUSIONS: More extensive information and education are required with respect to the various options and possibilities of pain control. Explanations of the mode of action and side-effects of pain medication in order to deal with the prejudices. Earlier and more focused use of pain therapy (long duration of pain), and use of coping aids for activities of daily living (limited through pain) and a broadening of the spectrum of treatment are all necessary. Patient satisfaction with pain therapy should be the main focus, as this is the deciding factor in terms of the quality of life.

Female↗
PubMed2002

Brain activation pattern as assessed with multi-modal EEG analysis predict motor recovery among stroke patients with mild arm paresis who receive the Arm Ability Training.

PURPOSE: Receiving the Arm Ability Training for three weeks improves motor function among stroke patients with mild arm paresis. There is, however, a considerable variability in recovery among patients receiving the Arm Ability Training. The study investigated whether intersubject differences in movement-related electric brain activity explain the variability in motor recovery. METHODS: In a sample of 9 patients receiving the Arm Ability Training both motor performance using a standardised arm function test (TEMPA) and movement-related electric brain activity, i.e. slow cortical potentials (DC) as well as event-related desynchronisation of alpha (alpha-ERD) and beta activity (beta-ERD), were assessed before the Arm Ability Training was started. Stepwise multiple regression was used to establish the best predictive model for motor improvement scores (TEMPA difference from pre to post test three weeks later). RESULTS: Stepwise multiple regression indicated that electric brain activity during movement preparation explained the variance of motor improvement scores completely. Further, electric brain activity during movement as well as baseline motor performance accounted each for 50% of the variance of motor improvement scores. CONCLUSIONS: Activation of sensorimotor areas during movement preparation and deactivation of other cortical areas during movement execution seem to be factors that predict a favourable outcome after training.

Aged↗
PubMed2002

Do psychological variables modify motor recovery among patients with mild arm paresis after stroke or traumatic brain injury who receive the Arm Ability Training?

PURPOSE: The Arm Ability Training improves motor function among stroke and traumatic brain injury patients with mild arm paresis. There is, however, a considerable variability in motor recovery among patients receiving the Arm Ability Training. The study investigated whether psychological variables can explain the variability in motor recovery. METHODS: In a sample of 33 patients receiving the Arm Ability Training both motor performance (by use of the standardised arm function test TEMPA) and cognitive functions (attention, perceptual abilities, and learning) as well as depression were assessed before training was commenced. Both univariate correlational analyses and stepwise multiple regression were used to investigate these variables' ability to predict motor improvement (TEMPA difference scores from pre to post test after 3 weeks). RESULTS: The degree of motor dysfunction of the affected arm explained most (70%) of the variance of motor improvement scores of the standardised arm function test (TEMPA). Psychometric scores showed no or at the most weak associations with motor improvement (explaining at the most 10% of the variance). CONCLUSIONS: Psychological variables had not been critical modifiers of motor recovery among stroke and traumatic brain injury patients with mild arm paresis receiving the Arm Ability Training.

Adolescent↗
PubMed2001

Reduced skilfulness of arm motor behaviour among motor stroke patients with good clinical recovery: does it indicate reduced automaticity? Can it be improved by unilateral or bilateral training? A kinematic motion analysis study.

Functional cortical reorganisation had been demonstrated to accompany recovery from motor stroke. In agreement with a previous study, quantitative kinematic analysis of aimed movements in 14 almost completely recovered hemiparetic stroke patients and 14 healthy control subjects indicated a reduced skilfulness of both the more ballistic initial movement phase and the more feedback-guided late homing-in phase of aimed movements. By means of two dual motor tasks it was further investigated whether the reduced skilfulness of patients was due to an increased attentional demand and thus a reduced automaticity of motor control. Interference effects by dual tasks, however, were similar for patients and control subjects. Thus, the notion of reduced automaticity could not be supported empirically, and reduced skilfulness seemed rather related to residual pyramidal motor deficits. By means of a repetitive daily training for 1 week based on the Arm Ability Training approach, patients were able to reduce their performance deficits in both movement phases significantly. Whether patients practised with the affected arm or simultaneously with both the affected and non-affected arm only marginally modified outcome, unilateral training being slightly more efficacious. These findings demonstrate that even clinically minor residual motor deficits can be improved by a structured training for the affected arm.

Adult↗
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↗
PubMed2001

Zotepine in the treatment of acute hospitalized schizophrenic episodes.

The atypical antipsychotic zotepine was studied in an open, multicentre uncontrolled, post-marketing surveillance study in 108 schizophrenic patients hospitalized in 12 trial centres in Austria. Within the dosage range of 50-450 mg (mean at the end of the study, 207 +/- 125 mg/day), a significant reduction of positive as well as negative symptoms was noted. There was no increase in extrapyramidal side-effects during the study and a significant decrease in akathisia scores. The medication was well tolerated during the 42-day observation period. Zotepine improved both positive and negative symptoms and was not accompanied by extrapyramidal side-effects, justifying its classification as an atypical antipsychotic.

Acute Disease↗
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

Training improves the speed of aimed movements in Parkinson's disease.

In this study, the extent to which bradykinesia in patients with idiopathic Parkinson's disease can be influenced by practice and by specific training strategies was investigated. Fifteen patients with Parkinson's disease tested after withdrawal of anti-Parkinson medication, and 15 matched control subjects, practised a ballistic aiming task. Performance was tested before, during and after training and again 1 h later. The Parkinson's disease patients and control subjects were randomly assigned to one of two training schedules, practising with or without rhythmic auditory cues. At baseline, the Parkinson's disease patients showed longer movement times, with a marked decrease in maximum acceleration and deceleration in the initial open-loop phase compared with those of the control subjects. With training, they were able to make significant improvement in the speed of aimed movements, particularly in the early movement phase, without any deterioration in accuracy. These effects transferred to an untrained limb and were at least partially maintained after a 1-h delay. While patients remained impaired relative to control subjects at all phases of training and follow-up, the patients' performance at the end of training did not differ significantly from the control subjects' baseline function. Contrary to expectation, rhythmic auditory cues did not enhance improvement in the speed of aimed movements in either patients or control subjects. If anything, less improvement was shown in the cued groups, although there were suggestions that the aiming skill was retained better over the delay period. The results demonstrate preserved abilities to improve speed of single ballistic aiming movements in Parkinson's disease patients and the possibility of reducing bradykinesia by training.

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↗