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Abstract
Stroke remains a major cause of disability. Intensive rehabilitation therapy can improve outcomes, but most patients receive limited doses. Telehealth methods can overcome obstacles to delivering intensive therapy and thereby address this unmet need. A specific example is reviewed in detail, focused on a telerehabilitation system that targets upper extremity motor deficits after stroke. Strengths of this system include provision of daily therapy associated with very high patient compliance, safety and feasibility in the inpatient or home setting, comparable efficacy to dose-matched therapy provided in-clinic, and a holistic approach that includes assessment, education, prevention, and activity-based therapy.
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Affiliation(s)
- Steven C Cramer
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA.
| | - Brittany M Young
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
| | - Anne Schwarz
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
| | - Tracy Y Chang
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
| | - Michael Su
- Department of Neurology, UCLA, Los Angeles, CA, USA; California Rehabilitation Institute, 2070 Century Park East, Los Angeles, CA 90067-1907, USA
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Wiesner K, Schwarz A, Meya L, Kaufmann JE, Traenka C, Luft AR, Held JPO, Engelter S. Interrater reliability of the Fugl-Meyer Motor assessment in stroke patients: a quality management project within the ESTREL study. Front Neurol 2024; 15:1335375. [PMID: 38651097 PMCID: PMC11034517 DOI: 10.3389/fneur.2024.1335375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/04/2024] [Indexed: 04/25/2024] Open
Abstract
Introduction The Fugl-Meyer Motor Assessment (FMMA) is recommended for evaluating stroke motor recovery in clinical practice and research. However, its widespread use requires refined reliability data, particularly across different health professions. We therefore investigated the interrater reliability of the FMMA scored by a physical therapist and a physician using video recordings of stroke patients. Methods The FMMA videos of 50 individuals 3 months post stroke (28 females, mean age 71.64 years, median National Institutes of Health Stroke Scale score 3.00) participating in the ESTREL trial (Enhancement of Stroke Rehabilitation with Levodopa: a randomized placebo-controlled trial) were independently scored by two experienced assessors (i.e., a physical therapist and a physician) with specific training to ensure consistency. As primary endpoint, the interrater reliability was calculated for the total scores of the entire FMMA and the total scores of the FMMA for the upper and lower extremities using intraclass correlation coefficients (ICC). In addition, Spearman's rank order correlation coefficients (Spearman's rho) were calculated for the total score and subscale levels. Secondary endpoints included the FMMA item scores using percentage agreement, weighted Cohen's kappa coefficients, and Gwet's AC1/AC2 coefficients. Results ICCs were 0.98 (95% confidence intervals (CI) 0.96-0.99) for the total scores of the entire FMMA, 0.98 (95% CI 0.96-0.99) for the total scores of the FMMA for the upper extremity, and 0.85 (95% CI 0.70-0.92) for the total scores of the FMMA for the lower extremity. Spearman's rho ranged from 0.61 to 0.94 for total and subscale scores. The interrater reliability at the item level of the FMMA showed (i) percentage agreement values with a median of 77% (range 44-100%), (ii) weighted Cohen's kappa coefficients with a median of 0.69 (range 0.00-0.98) and (iii) Gwet's AC1/AC2 coefficients with a median of 0.84 (range 0.42-0.98). Discussion and conclusion The FMMA appears to be a highly reliable measuring instrument at the overall score level for assessors from different health professions. The FMMA total scores seem to be suitable for the quantitative measurement of stroke recovery in both clinical practice and research, although there is potential for improvement at the item level.
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Affiliation(s)
- Karin Wiesner
- Neurorehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Louisa Meya
- Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Josefin Emelie Kaufmann
- Neurorehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
- Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Christopher Traenka
- Neurorehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
- Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Andreas Rüdiger Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Cereneo Center of Neurology and Rehabilitation, Zurich, Switzerland
| | - Jeremia Philipp Oskar Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- Valens Clinics, Reha Center Triemli, Vitznau, Switzerland
| | - Stefan Engelter
- Neurorehabilitation and Neurology, University Department of Geriatric Medicine FELIX PLATTER, University of Basel, Basel, Switzerland
- Department of Neurology and Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
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Neumann S, Bauer CM, Nastasi L, Läderach J, Thürlimann E, Schwarz A, Held JPO, Easthope CA. Accuracy, concurrent validity, and test-retest reliability of pressure-based insoles for gait measurement in chronic stroke patients. Front Digit Health 2024; 6:1359771. [PMID: 38633383 PMCID: PMC11021704 DOI: 10.3389/fdgth.2024.1359771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/11/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Wearables are potentially valuable tools for understanding mobility behavior in individuals with neurological disorders and how it changes depending on health status, such as after rehabilitation. However, the accurate detection of gait events, which are crucial for the evaluation of gait performance and quality, is challenging due to highly individual-specific patterns that also vary greatly in movement and speed, especially after stroke. Therefore, the purpose of this study was to assess the accuracy, concurrent validity, and test-retest reliability of a commercially available insole system in the detection of gait events and the calculation of stance duration in individuals with chronic stroke. Methods Pressure insole data were collected from 17 individuals with chronic stroke during two measurement blocks, each comprising three 10-min walking tests conducted in a clinical setting. The gait assessments were recorded with a video camera that served as a ground truth, and pressure insoles as an experimental system. We compared the number of gait events and stance durations between systems. Results and discussion Over all 3,820 gait events, 90.86% were correctly identified by the insole system. Recall values ranged from 0.994 to 1, with a precision of 1 for all measurements. The F1 score ranged from 0.997 to 1. Excellent absolute agreement (Intraclass correlation coefficient, ICC = 0.874) was observed for the calculation of the stance duration, with a slightly longer stance duration recorded by the insole system (difference of -0.01 s). Bland-Altmann analysis indicated limits of agreement of 0.33 s that were robust to changes in walking speed. This consistency makes the system well-suited for individuals post-stroke. The test-retest reliability between measurement timepoints T1 and T2 was excellent (ICC = 0.928). The mean difference in stance duration between T1 and T2 was 0.03 s. We conclude that the insole system is valid for use in a clinical setting to quantitatively assess continuous walking in individuals with stroke.
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Affiliation(s)
- Saskia Neumann
- DART, Lake Lucerne Institute, Vitznau, Switzerland
- Cereneo Foundation, Vitznau, Switzerland
| | | | - Luca Nastasi
- DART, Lake Lucerne Institute, Vitznau, Switzerland
- Cereneo Foundation, Vitznau, Switzerland
| | | | - Eva Thürlimann
- Vascular Neurology and Neurorehabilitation, University of Zurich, Zurich, Switzerland
| | - Anne Schwarz
- Vascular Neurology and Neurorehabilitation, University of Zurich, Zurich, Switzerland
| | - Jeremia P. O. Held
- Vascular Neurology and Neurorehabilitation, University of Zurich, Zurich, Switzerland
| | - Chris A. Easthope
- DART, Lake Lucerne Institute, Vitznau, Switzerland
- Cereneo Foundation, Vitznau, Switzerland
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Unger T, de Sousa Ribeiro R, Mokni M, Weikert T, Pohl J, Schwarz A, Held J, Sauerzopf L, Kühnis B, Gavagnin E, Luft A, Gassert R, Lambercy O, Awai Easthope C, Schönhammer J. Upper limb movement quality measures: comparing IMUs and optical motion capture in stroke patients performing a drinking task. Front Digit Health 2024; 6:1359776. [PMID: 38606036 PMCID: PMC11006959 DOI: 10.3389/fdgth.2024.1359776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/13/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Clinical assessment of upper limb sensorimotor function post-stroke is often constrained by low sensitivity and limited information on movement quality. To address this gap, recent studies proposed a standardized instrumented drinking task, as a representative daily activity combining different components of functional arm use. Although kinematic movement quality measures for this task are well-established, and optical motion capture (OMC) has proven effective in their measurement, its clinical application remains limited. Inertial Measurement Units (IMUs) emerge as a promising low-cost and user-friendly alternative, yet their validity and clinical relevance compared to the gold standard OMC need investigation. Method In this study, we conducted a measurement system comparison between IMUs and OMC, analyzing 15 established movement quality measures in 15 mild and moderate stroke patients performing the drinking task, using five IMUs placed on each wrist, upper arm, and trunk. Results Our findings revealed strong agreement between the systems, with 12 out of 15 measures demonstrating clinical applicability, evidenced by Limits of Agreement (LoA) below the Minimum Clinically Important Differences (MCID) for each measure. Discussion These results are promising, suggesting the clinical applicability of IMUs in quantifying movement quality for mildly and moderately impaired stroke patients performing the drinking task.
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Affiliation(s)
- T. Unger
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
- Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland
| | | | - M. Mokni
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
| | - T. Weikert
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
| | - J. Pohl
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
| | - A. Schwarz
- Department of Neurology, UCLA, Los Angeles, CA, United States
- California Rehabilitation Institute, Los Angeles, CA, United States
| | - J.P.O. Held
- Ambulante Reha Triemli Zurich, Zurich, Switzerland
| | - L. Sauerzopf
- ZHAW School of Health Sciences, Institute of Occupational Therapy, Winterthur, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - B. Kühnis
- ZHAW School of Management and Law, Institute of Business Information Technology, Winterthur, Switzerland
| | - E. Gavagnin
- ZHAW School of Management and Law, Institute of Business Information Technology, Winterthur, Switzerland
- ZHAW School of Engineering, Centre for Artificial Intelligence, Winterthur, Switzerland
| | - A.R. Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, University of Zurich and University Hospital Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - R. Gassert
- Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland
| | - O. Lambercy
- Rehabilitation Engineering Laboratory, ETH Zurich, Zurich, Switzerland
| | | | - J.G. Schönhammer
- DART Lab, Lake Lucerne Institute, Vitznau, Switzerland
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology and Clinical Neuroscience Center, University of Zurich and University Hospital Zurich, Zurich, Switzerland
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Ranzani R, Chiriatti G, Schwarz A, Devittori G, Gassert R, Lambercy O. An online method to monitor hand muscle tone during robot-assisted rehabilitation. Front Robot AI 2023; 10:1093124. [PMID: 36814447 PMCID: PMC9939644 DOI: 10.3389/frobt.2023.1093124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/24/2023] [Indexed: 02/08/2023] Open
Abstract
Introduction: Robot-assisted neurorehabilitation is becoming an established method to complement conventional therapy after stroke and provide intensive therapy regimes in unsupervised settings (e.g., home rehabilitation). Intensive therapies may temporarily contribute to increasing muscle tone and spasticity, especially in stroke patients presenting tone alterations. If sustained without supervision, such an increase in muscle tone could have negative effects (e.g., functional disability, pain). We propose an online perturbation-based method that monitors finger muscle tone during unsupervised robot-assisted hand therapy exercises. Methods: We used the ReHandyBot, a novel 2 degrees of freedom (DOF) haptic device to perform robot-assisted therapy exercises training hand grasping (i.e., flexion-extension of the fingers) and forearm pronosupination. The tone estimation method consisted of fast (150 ms) and slow (250 ms) 20 mm ramp-and-hold perturbations on the grasping DOF, which were applied during the exercises to stretch the finger flexors. The perturbation-induced peak force at the finger pads was used to compute tone. In this work, we evaluated the method performance in a stiffness identification experiment with springs (0.97 and 1.57 N/mm), which simulated the stiffness of a human hand, and in a pilot study with subjects with increased muscle tone after stroke and unimpaired, which performed one active sensorimotor exercise embedding the tone monitoring method. Results: The method accurately estimates forces with root mean square percentage errors of 3.8% and 11.3% for the soft and stiff spring, respectively. In the pilot study, six chronic ischemic stroke patients [141.8 (56.7) months after stroke, 64.3 (9.5) years old, expressed as mean (std)] and ten unimpaired subjects [59.9 (6.1) years old] were tested without adverse events. The average reaction force at the level of the fingertip during slow and fast perturbations in the exercise were respectively 10.7 (5.6) N and 13.7 (5.6) N for the patients and 5.8 (4.2) N and 6.8 (5.1) N for the unimpaired subjects. Discussion: The proposed method estimates reaction forces of physical springs accurately, and captures online increased reaction forces in persons with stroke compared to unimpaired subjects within unsupervised human-robot interactions. In the future, the identified range of muscle tone increase after stroke could be used to customize therapy for each subject and maintain safety during intensive robot-assisted rehabilitation.
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Affiliation(s)
- Raffaele Ranzani
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland,*Correspondence: Raffaele Ranzani,
| | - Giorgia Chiriatti
- Department of Industrial Engineering and Mathematical Science, Polytechnic University of Marche, Ancona, Italy
| | - Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Giada Devittori
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland,Future Health Technologies, Singapore—ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland,Future Health Technologies, Singapore—ETH Centre, Campus for Research Excellence And Technological Enterprise (CREATE), Singapore, Singapore
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Schwarz A, Al-Haj Husain A, Einaudi L, Thürlimann E, Läderach J, Awai Easthope C, Held JPO, Luft AR. Reliability and Validity of a Wearable Sensing System and Online Gait Analysis Report in Persons after Stroke. Sensors (Basel) 2023; 23:624. [PMID: 36679424 PMCID: PMC9862973 DOI: 10.3390/s23020624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 12/29/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
The restoration of gait and mobility after stroke is an important and challenging therapy goal due to the complexity of the potentially impaired functions. As a result, precise and clinically feasible assessment methods are required for personalized gait rehabilitation after stroke. The aim of this study is to investigate the reliability and validity of a sensor-based gait analysis system in stroke survivors with different severities of gait deficits. For this purpose, 28 chronic stroke survivors (9 women, ages: 62.04 ± 11.68 years) with mild to moderate walking impairments performed a set of ambulatory assessments (3× 10MWT, 1× 6MWT per session) twice while being equipped with a sensor suit. The derived gait reports provided information about speed, step length, step width, swing and stance phases, as well as joint angles of the hip, knee, and ankle, which we analyzed for test-retest reliability and hypothesis testing. Further, test-retest reliability resulted in a mean ICC of 0.78 (range: 0.46-0.88) for walking 10 m and a mean ICC of 0.90 (range: 0.63-0.99) for walking 6 min. Additionally, all gait parameters showed moderate-to-strong correlations with clinical scales reflecting lower limb function. These results support the applicability of this sensor-based gait analysis system for individuals with stroke-related walking impairments.
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Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Adib Al-Haj Husain
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Lorenzo Einaudi
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Eva Thürlimann
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
| | - Julia Läderach
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), 6354 Vitznau, Switzerland
| | - Chris Awai Easthope
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), 6354 Vitznau, Switzerland
| | - Jeremia P. O. Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
- Rehabilitation Center Triemli Zurich, Valens Clinics, 8063 Zurich, Switzerland
| | - Andreas R. Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, 8091 Zurich, Switzerland
- Cereneo, Center for Neurology and Rehabilitation, 6354 Vitznau, Switzerland
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Deseoe J, Schwarz A, Pipping T, Lehmann A, Veerbeek JM, Luft AR, Wegener S, Globas C, Held JPO. Cerebral blood flow velocity progressively decreases with increasing levels of verticalization in healthy adults. A cross-sectional study with an observational design. Front Neurol 2023; 14:1149673. [PMID: 37139076 PMCID: PMC10149656 DOI: 10.3389/fneur.2023.1149673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/20/2023] [Indexed: 05/05/2023] Open
Abstract
Background Autoregulation of the cerebral vasculature keeps brain perfusion stable over a range of systemic mean arterial pressures to ensure brain functioning, e.g., in different body positions. Verticalization, i.e., transfer from lying (0°) to upright (70°), which causes systemic blood pressure drop, would otherwise dramatically lower cerebral perfusion pressure inducing fainting. Understanding cerebral autoregulation is therefore a prerequisite to safe mobilization of patients in therapy. Aim We measured the impact of verticalization on cerebral blood flow velocity (CBFV) and systemic blood pressure (BP), heart rate (HR) and oxygen saturation in healthy individuals. Methods We measured CBFV in the middle cerebral artery (MCA) of the dominant hemisphere in 20 subjects using continuous transcranial doppler ultrasound (TCD). Subjects were verticalized at 0°, -5°, 15°, 30°, 45° and 70° for 3-5 min each, using a standardized Sara Combilizer chair. In addition, blood pressure, heart rate and oxygen saturation were continuously monitored. Results We show that CBFV progressively decreases in the MCA with increasing degrees of verticalization. Systolic and diastolic BP, as well as HR, show a compensatory increase during verticalization. Conclusion In healthy adults CBFV changes rapidly with changing levels of verticalization. The changes in the circulatory parameters are similar to results regarding classic orthostasis. Registration ClinicalTrials.gov, identifier: NCT04573114.
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Affiliation(s)
- Julian Deseoe
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Anne Schwarz
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Theodor Pipping
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Aurelia Lehmann
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Janne M. Veerbeek
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Andreas R. Luft
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christoph Globas
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- *Correspondence: Christoph Globas
| | - Jeremia P. O. Held
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Rehabilitation Center Triemli Zurich, Valens Clinics, Zurich, Switzerland
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Schwarz A, Bhagubai MMC, Nies SHG, Held JPO, Veltink PH, Buurke JH, Luft AR. Correction to: Characterization of stroke-related upper limb motor impairments across various upper limb activities by use of kinematic core set measures. J Neuroeng Rehabil 2022; 19:70. [PMID: 35820923 PMCID: PMC9277818 DOI: 10.1186/s12984-022-01048-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands.
| | - Miguel M C Bhagubai
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Saskia H G Nies
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Jeremia P O Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter H Veltink
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Jaap H Buurke
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands.,Roessingh Research and Development B.V., Enschede, The Netherlands
| | - Andreas R Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
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Kieslich M, Parwani A, Weber-Bärenbrinker S, Opgen-Rhein B, Schwarz A, Berger F, Will J. Successful Epicardial Mapping and Ablation of Ventricular Tachycardia after Failed Medical Therapy and Conventional Endocardial Ablation Therapy in a 10-Year-Old Girl with Severe Biventricular Arrhythmogenic Cardiomyopathy. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- M. Kieslich
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - A. Parwani
- Cardiology Charité University, Berlin, Deutschland
| | | | - B. Opgen-Rhein
- Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - A. Schwarz
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - F. Berger
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - J. Will
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland
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Schwarz A, Timme N, Kieslich M, Opgen-Rhein B, Weber-Bärenbrinker S, Berger F, Will J. Nonsustained Ventricular Tachycardia in Adolescents after mRNA-SARS-CoV-2 Vaccine: Report of Two Cases. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- A. Schwarz
- CharitéUniversitätsmedizin Berlin, Berlin, Deutschland
| | - N. Timme
- CharitéUniversitätsmedizin Berlin, Berlin, Deutschland
| | - M. Kieslich
- CharitéUniversitätsmedizin Berlin, Berlin, Deutschland
| | | | | | - F. Berger
- CharitéUniversitätsmedizin Berlin, Berlin, Deutschland
| | - J. Will
- CharitéUniversitätsmedizin Berlin, Berlin, Deutschland
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Schwarz A, Bhagubai MMC, Nies SHG, Held JPO, Veltink PH, Buurke JH, Luft AR. Characterization of stroke-related upper limb motor impairments across various upper limb activities by use of kinematic core set measures. J Neuroeng Rehabil 2022; 19:2. [PMID: 35016694 PMCID: PMC8753836 DOI: 10.1186/s12984-021-00979-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background Upper limb kinematic assessments provide quantifiable information on qualitative movement behavior and limitations after stroke. A comprehensive characterization of spatiotemporal kinematics of stroke subjects during upper limb daily living activities is lacking. Herein, kinematic expressions were investigated with respect to different movement types and impairment levels for the entire task as well as for motion subphases. Method Chronic stroke subjects with upper limb movement impairments and healthy subjects performed a set of daily living activities including gesture and grasp movements. Kinematic measures of trunk displacement, shoulder flexion/extension, shoulder abduction/adduction, elbow flexion/extension, forearm pronation/supination, wrist flexion/extension, movement time, hand peak velocity, number of velocity peaks (NVP), and spectral arc length (SPARC) were extracted for the whole movement as well as the subphases of reaching distally and proximally. The effects of the factors gesture versus grasp movements, and the impairment level on the kinematics of the whole task were tested. Similarities considering the metrics expressions and relations were investigated for the subphases of reaching proximally and distally between tasks and subgroups. Results Data of 26 stroke and 5 healthy subjects were included. Gesture and grasp movements were differently expressed across subjects. Gestures were performed with larger shoulder motions besides higher peak velocity. Grasp movements were expressed by larger trunk, forearm, and wrist motions. Trunk displacement, movement time, and NVP increased and shoulder flexion/extension decreased significantly with increased impairment level. Across tasks, phases of reaching distally were comparable in terms of trunk displacement, shoulder motions and peak velocity, while reaching proximally showed comparable expressions in trunk motions. Consistent metric relations during reaching distally were found between shoulder flexion/extension, elbow flexion/extension, peak velocity, and between movement time, NVP, and SPARC. Reaching proximally revealed reproducible correlations between forearm pronation/supination and wrist flexion/extension, movement time and NVP. Conclusion Spatiotemporal differences between gestures versus grasp movements and between different impairment levels were confirmed. The consistencies of metric expressions during movement subphases across tasks can be useful for linking kinematic assessment standards and daily living measures in future research and performing task and study comparisons. Trial registration: ClinicalTrials.gov Identifier NCT03135093. Registered 26 April 2017, https://clinicaltrials.gov/ct2/show/NCT03135093.
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Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland. .,Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands.
| | - Miguel M C Bhagubai
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Saskia H G Nies
- Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Jeremia P O Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Peter H Veltink
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Jaap H Buurke
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands.,Roessingh Research and Development B.V., Enschede, The Netherlands
| | - Andreas R Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
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12
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Bonaterra GA, Struck N, Zuegel S, Schwarz A, Mey L, Schwarzbach H, Strelau J, Kinscherf R. Characterization of atherosclerotic plaques in blood vessels with low oxygenated blood and blood pressure (Pulmonary trunk): role of growth differentiation factor-15 (GDF-15). BMC Cardiovasc Disord 2021; 21:601. [PMID: 34920697 PMCID: PMC8684150 DOI: 10.1186/s12872-021-02420-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Growth differentiation factor (GDF)-15 is linked to inflammation, cancer, and atherosclerosis. GDF-15 is expressed in most tissues but is extremely induced under pathological conditions. Elevated serum levels are suggested as a risk factor and a marker for cardiovascular diseases. However, the cellular sources and the effects of GDF-15 on the cardiovascular system have not been completely elucidated including progression, and morphology of atherosclerotic plaques. Thus, this work aimed to characterize the influence of GDF-15 deficiency on the morphology of atherosclerotic plaques in blood vessels with low-oxygen blood and low blood pressure as the pulmonary trunk (PT), in hypercholesterolemic ApoE-/- mice. METHODS GDF-15-/- ApoE-/- mice were generated by crossbreeding of ApoE-/-- and GDF-15-/- mice. After feeding a cholesterol-enriched diet (CED) for 20 weeks, samples of the brachiocephalic trunk (BT) and PT were dissected and lumen stenosis (LS) was measured. Furthermore, changes in the cellularity of the PT, amounts of apoptosis-, autophagy-, inflammation- and proliferation-relevant proteins were immunohisto-morphometrically analyzed. Additionally, we examined an atherosclerotic plaque in a human post mortem sample of the pulmonary artery. RESULTS After CED the body weight of GDF-15-/-ApoE-/- was 22.9% higher than ApoE-/-. Double knockout mice showed also an 35.3% increase of plasma triglyceride levels, whereas plasma cholesterol was similar in both genotypes. LS in the BT and PT of GDF-15-/-ApoE-/- mice was significantly reduced by 19.0% and by 6.7% compared to ApoE-/-. Comparing LS in PT and BT of the same genotype revealed a significant 38.8% (ApoE-/-) or 26.4% (GDF-15-/-ApoE-/-) lower LS in the PT. Immunohistomorphometry of atherosclerotic lesions in PT of GDF-15-/-ApoE-/- revealed significantly increased levels (39.8% and 7.3%) of CD68 + macrophages (MΦ) and α-actin + smooth muscle cells than in ApoE-/-. The density of TUNEL + , apoptotic cells was significantly (32.9%) higher in plaques of PT of GDF-15-/-ApoE-/- than in ApoE-/-. Analysis of atherosclerotic lesion of a human pulmonary artery showed sm-α-actin, CD68+, TUNEL+, Ki67+, and APG5L/ATG+ cells as observed in PT. COX-2+ and IL-6+ immunoreactivities were predominantly located in endothelial cells and subendothelial space. In BT and PT of GDF15-/-ApoE-/- mice the necrotic area was 10% and 6.5% lower than in ApoE-/-. In BT and PT of GDF15-/-ApoE-/- we found 40% and 57% less unstable plaques than ApoE-/- mice. CONCLUSIONS Atherosclerotic lesions occur in both, BT and PT, however, the size is smaller in PT, possibly due to the effect of the low-oxygen blood and/or lower blood pressure. GDF-15 is involved in atherosclerotic processes in BT and PT, although different mechanisms (e.g. apoptosis) in these two vessels seem to exist.
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Affiliation(s)
- G A Bonaterra
- Institute for Anatomy and Cell Biology, Department of Medical Cell Biology, University of Marburg, 35032, Marburg, Germany.
| | - N Struck
- Institute for Anatomy and Cell Biology, Department of Medical Cell Biology, University of Marburg, 35032, Marburg, Germany
| | - S Zuegel
- Institute for Anatomy and Cell Biology, Department of Medical Cell Biology, University of Marburg, 35032, Marburg, Germany
| | - A Schwarz
- Institute for Anatomy and Cell Biology, Department of Medical Cell Biology, University of Marburg, 35032, Marburg, Germany
| | - L Mey
- Institute for Anatomy and Cell Biology, Department of Medical Cell Biology, University of Marburg, 35032, Marburg, Germany
| | - H Schwarzbach
- Institute for Anatomy and Cell Biology, Department of Medical Cell Biology, University of Marburg, 35032, Marburg, Germany
| | - J Strelau
- Department of Functional Neuroanatomy, University of Heidelberg, 69120, Heidelberg, Germany
| | - R Kinscherf
- Institute for Anatomy and Cell Biology, Department of Medical Cell Biology, University of Marburg, 35032, Marburg, Germany
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13
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Held JPO, Schwarz A, Pohl J, Thürlimann E, Porrtmann S, Branscheidt M, Fratian M, Van Duinen J, Veerbeek JM, Luft AR. Changes in stroke rehabilitation during the SARS-CoV-2 shutdown in Switzerland. J Rehabil Med 2021; 54:jrm00272. [PMID: 34927210 PMCID: PMC8902586 DOI: 10.2340/jrm.v53.1118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Many stroke survivors require continuous outpatient rehabilitation therapy to maintain or improve their neurological functioning, independence, and quality of life. In Switzerland and many other countries, the shutdown to contain SARS-CoV-2 infections led to mobility restrictions and a decrease in therapy delivery. This study investigated the impact of the COVID-19 shutdown on stroke survivors’ access to therapy, physical activity, functioning and mood. Methods A prospective observational cohort study in stroke subjects. At 4 time-points (before, during, after the shutdown, and at 3-month follow-up), the amount of therapy, physical activities, motor function, anxiety, and depression were assessed. Results Thirty-six community-dwelling stroke subjects (median 70 years of age, 10 months post-stroke) were enrolled. Therapy reductions related to the shutdown were reported in 72% of subjects. This decrease was associated with significantly extended sedentary time and minimal deterioration in physical activity during the shutdown. Both parameters improved between reopening and 3-month follow-up. Depressive symptoms increased slightly during the observation period. Patients more frequently reported on self-directed training during shutdown. Conclusion The COVID-19 shutdown had measurable immediate, but no persistent, effects on post-stroke outcomes, except for depression. Importantly, a 2-month reduction in therapy may trigger improvements when therapy is fully re-initiated thereafter.
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Affiliation(s)
- Jeremia P O Held
- University and University Hospital Zurich, Neurology, Frauenklinikstrasse 26, 8091 Zurich.
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14
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Anarte-Lazo E, Carvalho GF, Schwarz A, Luedtke K, Falla D. Differentiating migraine, cervicogenic headache and asymptomatic individuals based on physical examination findings: a systematic review and meta-analysis. BMC Musculoskelet Disord 2021; 22:755. [PMID: 34479514 PMCID: PMC8417979 DOI: 10.1186/s12891-021-04595-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migraine and cervicogenic headache (CGH) are common headache disorders, although the large overlap of symptoms between them makes differential diagnosis challenging. To strengthen differential diagnosis, physical testing has been used to examine for the presence of musculoskeletal impairments in both conditions. This review aimed to systematically evaluate differences in physical examination findings between people with migraine, CGH and asymptomatic individuals. METHODS The databases MEDLINE, PubMed, CINAHL, Web of Science, Scopus, EMBASE were searched from inception until January 2020. Risk of bias was assessed with the Downs and Black Scale for non-randomized controlled trials, and with the Quality Assessment of Diagnostic Accuracy Studies tool for diagnostic accuracy studies. When possible, meta-analyses with random effect models was performed. RESULTS From 19,682 articles, 62 studies were included in this review and 41 were included in the meta-analyses. The results revealed: a) decreased range of motion [°] (ROM) on the flexion-rotation test (FRT) (17.67, 95%CI:13.69,21.65) and reduced neck flexion strength [N] (23.81, 95%CI:8.78,38.85) in CGH compared to migraine; b) compared to controls, migraineurs exhibit reduced flexion ROM [°] (- 2.85, 95%CI:-5.12,-0.58), lateral flexion ROM [°] (- 2.17, 95% CI:-3.75,-0.59) and FRT [°] (- 8.96, 95%CI:-13.22,-4.69), reduced cervical lordosis angle [°] (- 0.89, 95%CI:-1.72,-0.07), reduced pressure pain thresholds over the cranio-cervical region [kg/cm2], reduced neck extension strength [N] (- 11.13, 95%CI:-16.66,-5.6) and increased activity [%] of the trapezius (6.18, 95%CI:2.65,9.71) and anterior scalene muscles (2.87, 95%CI:0.81,4.94) during performance of the cranio-cervical flexion test; c) compared to controls, CGH patients exhibit decreased neck flexion (- 33.70, 95%CI:-47.23,-20.16) and extension (- 55.78, 95%CI:-77.56,-34.00) strength [N]. CONCLUSION The FRT and neck flexion strength could support the differential diagnosis of CGH from migraine. Several physical tests were found to differentiate both headache types from asymptomatic individuals. Nevertheless, additional high-quality studies are required to corroborate these findings. STUDY REGISTRATION Following indications of Prisma-P guidelines, this protocol was registered in PROSPERO on 21/05/2019 with the number CRD42019135269 . All amendments performed during the review were registered in PROSPERO, indicating the date and what and why was changed.
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Affiliation(s)
- E Anarte-Lazo
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), College of Life and Environmental Sciences, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - G F Carvalho
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany
| | - A Schwarz
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany
| | - K Luedtke
- Department of Physiotherapy, Pain and Exercise Research Luebeck (P.E.R.L.), Institute of Health Sciences, University of Luebeck, Luebeck, Germany
| | - D Falla
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), College of Life and Environmental Sciences, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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15
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Schwarz A, Pollmann S, Bonaterra G, Kinscherf R. PACAP antagonizes oxldl-induced lipid-/triglyceride accumulation and VPAC1-expression in human M2-MΦ. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Almer G, Brunner M, Schwarz A, Diwoky C, Lechleitner M, Sommer G, Kolb D, Wolinski H, Oswald W, Opriessnig P, Hörl G, Groselj-Strele A, Höfler G, Rechberger G, Frank S, Holzapfel G, Kratky D, Mangge H, Tehlivets O. Elevated homocysteine induces atherosclerosis-related changes in aortic rabbit walls in the absence of hypercholesterolemia. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Averta G, Barontini F, Catrambone V, Haddadin S, Handjaras G, Held JPO, Hu T, Jakubowitz E, Kanzler CM, Kühn J, Lambercy O, Leo A, Obermeier A, Ricciardi E, Schwarz A, Valenza G, Bicchi A, Bianchi M. U-Limb: A multi-modal, multi-center database on arm motion control in healthy and post-stroke conditions. Gigascience 2021; 10:giab043. [PMID: 34143875 PMCID: PMC8212873 DOI: 10.1093/gigascience/giab043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/26/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Shedding light on the neuroscientific mechanisms of human upper limb motor control, in both healthy and disease conditions (e.g., after a stroke), can help to devise effective tools for a quantitative evaluation of the impaired conditions, and to properly inform the rehabilitative process. Furthermore, the design and control of mechatronic devices can also benefit from such neuroscientific outcomes, with important implications for assistive and rehabilitation robotics and advanced human-machine interaction. To reach these goals, we believe that an exhaustive data collection on human behavior is a mandatory step. For this reason, we release U-Limb, a large, multi-modal, multi-center data collection on human upper limb movements, with the aim of fostering trans-disciplinary cross-fertilization. CONTRIBUTION This collection of signals consists of data from 91 able-bodied and 65 post-stroke participants and is organized at 3 levels: (i) upper limb daily living activities, during which kinematic and physiological signals (electromyography, electro-encephalography, and electrocardiography) were recorded; (ii) force-kinematic behavior during precise manipulation tasks with a haptic device; and (iii) brain activity during hand control using functional magnetic resonance imaging.
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Affiliation(s)
- Giuseppe Averta
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
- Soft Robotics for Human Cooperation and Rehabilitation, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Federica Barontini
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
- Soft Robotics for Human Cooperation and Rehabilitation, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Vincenzo Catrambone
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
| | - Sami Haddadin
- RSI - Chair of Robotics and Systems Intelligence, Munich School of Robotics and Machine Intelligence, Technical University Munich (TUM), Heßstr. 134, 80797 München, Germany
| | - Giacomo Handjaras
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Jeremia P O Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, Frauenklinikstrasse 26, 8006 Zürich, Switzerland
| | - Tingli Hu
- RSI - Chair of Robotics and Systems Intelligence, Munich School of Robotics and Machine Intelligence, Technical University Munich (TUM), Heßstr. 134, 80797 München, Germany
| | - Eike Jakubowitz
- Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, L384, 30625 Hannover, Germany
| | - Christoph M Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, CLA H 1.1 Tannenstrasse 3, 8092 Zurich, Switzerland
| | - Johannes Kühn
- RSI - Chair of Robotics and Systems Intelligence, Munich School of Robotics and Machine Intelligence, Technical University Munich (TUM), Heßstr. 134, 80797 München, Germany
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, CLA H 1.1 Tannenstrasse 3, 8092 Zurich, Switzerland
| | - Andrea Leo
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Alina Obermeier
- Laboratory for Biomechanics and Biomaterials (LBB), Department of Orthopaedic Surgery, Hannover Medical School, L384, 30625 Hannover, Germany
| | - Emiliano Ricciardi
- MoMiLab Research Unit, IMT School for Advanced Studies Lucca, Piazza S. Francesco 19, 55100 Lucca, Italy
| | - Anne Schwarz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University of Zurich, Frauenklinikstrasse 26, 8006 Zürich, Switzerland
| | - Gaetano Valenza
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
| | - Antonio Bicchi
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
- Soft Robotics for Human Cooperation and Rehabilitation, Fondazione Istituto Italiano di Tecnologia, Via Morego 30, 16163 Genova, Italy
| | - Matteo Bianchi
- Research Center “Enrico Piaggio” and Dipartimento di Ingegneria dell’Informazione, University of Pisa Largo Lucio Lazzarino 1, 56122 Pisa, Italy
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Krakauer JW, Kitago T, Goldsmith J, Ahmad O, Roy P, Stein J, Bishop L, Casey K, Valladares B, Harran MD, Cortés JC, Forrence A, Xu J, DeLuzio S, Held JP, Schwarz A, Steiner L, Widmer M, Jordan K, Ludwig D, Moore M, Barbera M, Vora I, Stockley R, Celnik P, Zeiler S, Branscheidt M, Kwakkel G, Luft AR. Comparing a Novel Neuroanimation Experience to Conventional Therapy for High-Dose Intensive Upper-Limb Training in Subacute Stroke: The SMARTS2 Randomized Trial. Neurorehabil Neural Repair 2021; 35:393-405. [PMID: 33745372 DOI: 10.1177/15459683211000730] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Evidence from animal studies suggests that greater reductions in poststroke motor impairment can be attained with significantly higher doses and intensities of therapy focused on movement quality. These studies also indicate a dose-timing interaction, with more pronounced effects if high-intensity therapy is delivered in the acute/subacute, rather than chronic, poststroke period. OBJECTIVE To compare 2 approaches of delivering high-intensity, high-dose upper-limb therapy in patients with subacute stroke: a novel exploratory neuroanimation therapy (NAT) and modified conventional occupational therapy (COT). METHODS A total of 24 patients were randomized to NAT or COT and underwent 30 sessions of 60 minutes time-on-task in addition to standard care. The primary outcome was the Fugl-Meyer Upper Extremity motor score (FM-UE). Secondary outcomes included Action Research Arm Test (ARAT), grip strength, Stroke Impact Scale hand domain, and upper-limb kinematics. Outcomes were assessed at baseline, and days 3, 90, and 180 posttraining. Both groups were compared to a matched historical cohort (HC), which received only 30 minutes of upper-limb therapy per day. RESULTS There were no significant between-group differences in FM-UE change or any of the secondary outcomes at any timepoint. Both high-dose groups showed greater recovery on the ARAT (7.3 ± 2.9 points; P = .011) but not the FM-UE (1.4 ± 2.6 points; P = .564) when compared with the HC. CONCLUSIONS Neuroanimation may offer a new, enjoyable, efficient, and scalable way to deliver high-dose and intensive upper-limb therapy.
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Affiliation(s)
| | - Tomoko Kitago
- Burke Neurological Institute, White Plains, NY, USA.,Weill Cornell Medicine, New York, NY, USA.,Columbia University, New York, NY, USA
| | - Jeff Goldsmith
- Columbia University Mailman School of Public Health, New York, NY, USA
| | - Omar Ahmad
- Johns Hopkins University, Baltimore, MD, USA
| | - Promit Roy
- Johns Hopkins University, Baltimore, MD, USA
| | - Joel Stein
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Lauri Bishop
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Kelly Casey
- Johns Hopkins University, Baltimore, MD, USA
| | - Belen Valladares
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.,University Hospital and University of Zurich, Switzerland
| | | | - Juan Camilo Cortés
- Johns Hopkins University, Baltimore, MD, USA.,Columbia University, New York, NY, USA
| | | | - Jing Xu
- Johns Hopkins University, Baltimore, MD, USA
| | | | - Jeremia P Held
- University Hospital and University of Zurich, Switzerland
| | - Anne Schwarz
- University Hospital and University of Zurich, Switzerland
| | - Levke Steiner
- University Hospital and University of Zurich, Switzerland
| | - Mario Widmer
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | | | | | | | | | - Isha Vora
- Johns Hopkins University, Baltimore, MD, USA
| | | | | | | | | | - Gert Kwakkel
- Vrije Universiteit Amsterdam, Netherlands.,Amsterdam Rehabilitation Research Centre, Reade, Netherlands
| | - Andreas R Luft
- cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland.,University Hospital and University of Zurich, Switzerland
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19
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Schwarz A, Veerbeek JM, Held JPO, Buurke JH, Luft AR. Measures of Interjoint Coordination Post-stroke Across Different Upper Limb Movement Tasks. Front Bioeng Biotechnol 2021; 8:620805. [PMID: 33585418 PMCID: PMC7876346 DOI: 10.3389/fbioe.2020.620805] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/18/2020] [Indexed: 01/26/2023] Open
Abstract
Background: Deficits in interjoint coordination, such as the inability to move out of synergy, are frequent symptoms in stroke subjects with upper limb impairments that hinder them from regaining normal motor function. Kinematic measurements allow a fine-grained assessment of movement pathologies, thereby complementing clinical scales, like the Fugl–Meyer Motor Assessment of the Upper Extremity (FMMA-UE). The study goal was to investigate the effects of the performed task, the tested arm, the dominant affected hand, upper limb function, and age on spatiotemporal parameters of the elbow, shoulder, and trunk. The construct validity of the metrics was examined by relating them with each other, the FMMA-UE, and its arm section. Methods: This is a cross-sectional observational study including chronic stroke patients with mild to moderate upper limb motor impairment. Kinematic measurements were taken using a wearable sensor suit while performing four movements with both upper limbs: (1) isolated shoulder flexion, (2) pointing, (3) reach-to-grasp a glass, and (4) key insertion. The kinematic parameters included the joint ranges of shoulder abduction/adduction, shoulder flexion/extension, and elbow flexion/extension; trunk displacement; shoulder–elbow correlation coefficient; median slope; and curve efficiency. The effects of the task and tested arm on the metrics were investigated using a mixed-model analysis. The validity of metrics compared to clinically measured interjoint coordination (FMMA-UE) was done by correlation analysis. Results: Twenty-six subjects were included in the analysis. The movement task and tested arm showed significant effects (p < 0.05) on all kinematic parameters. Hand dominance resulted in significant effects on shoulder flexion/extension and curve efficiency. The level of upper limb function showed influences on curve efficiency and the factor age on median slope. Relations with the FMMA-UE revealed the strongest and significant correlation for curve efficiency (r = 0.75), followed by shoulder flexion/extension (r = 0.68), elbow flexion/extension (r = 0.53), and shoulder abduction/adduction (r = 0.49). Curve efficiency additionally correlated significantly with the arm subsection, focusing on synergistic control (r = 0.59). Conclusion: The kinematic parameters of the upper limb after stroke were influenced largely by the task. These results underpin the necessity to assess different relevant functional movements close to real-world conditions rather than relying solely on clinical measures. Study Registration: clinicaltrials.gov, identifier NCT03135093 and BASEC-ID 2016-02075.
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Affiliation(s)
- Anne Schwarz
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Biomedical Signals and Systems (BSS), University of Twente, Enschede, Netherlands
| | - Janne M Veerbeek
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jeremia P O Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Jaap H Buurke
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, Netherlands.,Roessingh Research and Development B.V., Enschede, Netherlands
| | - Andreas R Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.,Cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland
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Bhagubai MMC, Wolterink G, Schwarz A, Held JPO, Van Beijnum BJF, Veltink PH. Quantifying Pathological Synergies in the Upper Extremity of Stroke Subjects With the Use of Inertial Measurement Units: A Pilot Study. IEEE J Transl Eng Health Med 2020; 9:2100211. [PMID: 33344099 PMCID: PMC7742824 DOI: 10.1109/jtehm.2020.3042931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/06/2020] [Accepted: 11/24/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Stroke is one of the main causes of disability in the world, causing loss of motor function on mainly one side of the body. A proper assessment of motor function is required to help to direct and evaluate therapy. Assessment is currently performed by therapists using observer-based standardized clinical assessment protocols. Sensor-based technologies can be used to objectively quantify the presence and severity of motor impairments in stroke patients. METHODS In this work, a minimally obstructive distributed inertial sensing system, intended to measure kinematics of the upper extremity, was developed and tested in a pilot study, where 10 chronic stroke subjects performed the arm-related tasks from the Fugl-Meyer Assessment protocol with the affected and non-affected side. RESULTS The pilot study showed that the developed distributed measurement system was adequately sensitive to show significant differences in stroke subjects' arm postures between the affected and non-affected side. The presence of pathological synergies can be analysed using the measured joint angles of the upper limb segments, that describe the movement patterns of the subject. CONCLUSION Features measured by the system vary from the assessed FMA-UE sub-score showing its potential to provide more detailed clinical information.
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Affiliation(s)
- Miguel M C Bhagubai
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands
| | - Gerjan Wolterink
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands.,Robotics and Mechatronics GroupUniversity of Twente7522NHEnschedeThe Netherlands
| | - Anne Schwarz
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands.,Division of Vascular Neurology and NeurorehabilitationDepartment of NeurologyUniversity Hospital Zürich, University of Zürich8091ZürichSwitzerland
| | - Jeremia P O Held
- Division of Vascular Neurology and NeurorehabilitationDepartment of NeurologyUniversity Hospital Zürich, University of Zürich8091ZürichSwitzerland
| | - Bert-Jan F Van Beijnum
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands
| | - Peter H Veltink
- Biomedical Signals and Systems~(BSS) Research GroupUniversity of Twente7522LWEnschedeThe Netherlands
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Rohse P, Butlewski J, Klein F, Wagner T, Friesen C, Schwarz A, Wiesendanger R, Sengstock K, Becker C. A cavity optomechanical locking scheme based on the optical spring effect. Rev Sci Instrum 2020; 91:103102. [PMID: 33138582 DOI: 10.1063/5.0010255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/12/2020] [Indexed: 06/11/2023]
Abstract
We present a novel locking scheme for active length-stabilization and frequency detuning of a cavity optomechanical device based on the optical spring effect. The error signal is generated by utilizing the position measurement of a thermally driven intra-cavity nanomechanical device and employing its detuning-dependent frequency shift caused by the dispersive coupling to the cavity field. The scheme neither requires external modulation of the laser or the cavity nor does it demand for additional error signal readout, rendering its technical implementation rather simple for a large variety of existing optomechanical devices. Specifically, for large-linewidth microcavities or in situations where other locking schemes appear unfavorable conceptually or are hard to realize technically, the optical spring lock represents a potential alternative for stabilizing the cavity length. We explain the functional principle of the lock and characterize its performance in terms of bandwidth and gain profile.
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Affiliation(s)
- P Rohse
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - J Butlewski
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - F Klein
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - T Wagner
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - C Friesen
- INF (Institut für Nanostruktur- und Festkörperphysik), Universität Hamburg, Jungiusstraße 9, 20355 Hamburg, Germany
| | - A Schwarz
- INF (Institut für Nanostruktur- und Festkörperphysik), Universität Hamburg, Jungiusstraße 9, 20355 Hamburg, Germany
| | - R Wiesendanger
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - K Sengstock
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
| | - C Becker
- ZOQ (Zentrum für Optische Quantentechnologien), Universität Hamburg, Luruper Chaussee 149, 22761 Hamburg, Germany
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Kanzler CM, Schwarz A, Held JPO, Luft AR, Gassert R, Lambercy O. Technology-aided assessment of functionally relevant sensorimotor impairments in arm and hand of post-stroke individuals. J Neuroeng Rehabil 2020; 17:128. [PMID: 32977810 PMCID: PMC7517659 DOI: 10.1186/s12984-020-00748-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/20/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Assessing arm and hand sensorimotor impairments that are functionally relevant is essential to optimize the impact of neurorehabilitation interventions. Technology-aided assessments should provide a sensitive and objective characterization of upper limb impairments, but often provide arm weight support and neglect the importance of the hand, thereby questioning their functional relevance. The Virtual Peg Insertion Test (VPIT) addresses these limitations by quantifying arm and hand movements as well as grip forces during a goal-directed manipulation task requiring active lifting of the upper limb against gravity. The aim of this work was to evaluate the ability of the VPIT metrics to characterize arm and hand sensorimotor impairments that are relevant for performing functional tasks. METHODS Arm and hand sensorimotor impairments were systematically characterized in 30 chronic stroke patients using conventional clinical scales and the VPIT. For the latter, ten previously established kinematic and kinetic core metrics were extracted. The validity and robustness of these metrics was investigated by analyzing their clinimetric properties (test-retest reliability, measurement error, learning effects, concurrent validity). RESULTS Twenty-three of the participants, the ones with mild to moderate sensorimotor impairments and without strong cognitive deficits, were able to successfully complete the VPIT protocol (duration 16.6 min). The VPIT metrics detected impairments in arm and hand in 90.0% of the participants, and were sensitive to increased muscle tone and pathological joint coupling. Most importantly, significant moderate to high correlations between conventional scales of activity limitations and the VPIT metrics were found, thereby indicating their functional relevance when grasping and transporting objects, and when performing dexterous finger manipulations. Lastly, the robustness of three out of the ten VPIT core metrics in post-stroke individuals was confirmed. CONCLUSIONS This work provides evidence that technology-aided assessments requiring goal-directed manipulations without arm weight support can provide an objective, robust, and clinically feasible way to assess functionally relevant sensorimotor impairments in arm and hand in chronic post-stroke individuals with mild to moderate deficits. This allows for a better identification of impairments with high functional relevance and can contribute to optimizing the functional benefits of neurorehabilitation interventions.
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Affiliation(s)
- Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Zurich, Switzerland
- Biomedical Signals and Systems (BSS), University of Twente, Enschede, The Netherlands
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Andreas R. Luft
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Zurich, Switzerland
| | - Roger Gassert
- Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- cereneo, Center for Neurology and Rehabilitation, Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
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Schwarz A, Bhagubai MMC, Wolterink G, Held JPO, Luft AR, Veltink PH. Assessment of Upper Limb Movement Impairments after Stroke Using Wearable Inertial Sensing. Sensors (Basel) 2020; 20:s20174770. [PMID: 32846958 PMCID: PMC7506737 DOI: 10.3390/s20174770] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 11/23/2022]
Abstract
Precise and objective assessments of upper limb movement quality after strokes in functional task conditions are an important prerequisite to improve understanding of the pathophysiology of movement deficits and to prove the effectiveness of interventions. Herein, a wearable inertial sensing system was used to capture movements from the fingers to the trunk in 10 chronic stroke subjects when performing reach-to-grasp activities with the affected and non-affected upper limb. It was investigated whether the factors, tested arm, object weight, and target height, affect the expressions of range of motion in trunk compensation and flexion-extension of the elbow, wrist, and finger during object displacement. The relationship between these metrics and clinically measured impairment was explored. Nine subjects were included in the analysis, as one had to be excluded due to defective data. The tested arm and target height showed strong effects on all metrics, while an increased object weight showed effects on trunk compensation. High inter- and intrasubject variability was found in all metrics without clear relationships to clinical measures. Relating all metrics to each other resulted in significant negative correlations between trunk compensation and elbow flexion-extension in the affected arm. The findings support the clinical usability of sensor-based motion analysis.
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Affiliation(s)
- Anne Schwarz
- Biomedical Signals and Systems (BSS), University of Twente, 7500 AE Enschede, The Netherlands; (M.M.C.B.); (G.W.); (P.H.V.)
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (J.P.O.H.); (A.R.L.)
- Correspondence:
| | - Miguel M. C. Bhagubai
- Biomedical Signals and Systems (BSS), University of Twente, 7500 AE Enschede, The Netherlands; (M.M.C.B.); (G.W.); (P.H.V.)
| | - Gerjan Wolterink
- Biomedical Signals and Systems (BSS), University of Twente, 7500 AE Enschede, The Netherlands; (M.M.C.B.); (G.W.); (P.H.V.)
- Robotics and Mechatronics group, University of Twente, 7500 AE Enschede, The Netherlands
| | - Jeremia P. O. Held
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (J.P.O.H.); (A.R.L.)
| | - Andreas R. Luft
- Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, 8091 Zurich, Switzerland; (J.P.O.H.); (A.R.L.)
- Cereneo, Center for Neurology and Rehabilitation, 6354 Vitznau, Switzerland
| | - Peter H. Veltink
- Biomedical Signals and Systems (BSS), University of Twente, 7500 AE Enschede, The Netherlands; (M.M.C.B.); (G.W.); (P.H.V.)
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Kanzler CM, Rinderknecht MD, Schwarz A, Lamers I, Gagnon C, Held JPO, Feys P, Luft AR, Gassert R, Lambercy O. A data-driven framework for selecting and validating digital health metrics: use-case in neurological sensorimotor impairments. NPJ Digit Med 2020; 3:80. [PMID: 32529042 PMCID: PMC7260375 DOI: 10.1038/s41746-020-0286-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/28/2020] [Indexed: 01/29/2023] Open
Abstract
Digital health metrics promise to advance the understanding of impaired body functions, for example in neurological disorders. However, their clinical integration is challenged by an insufficient validation of the many existing and often abstract metrics. Here, we propose a data-driven framework to select and validate a clinically relevant core set of digital health metrics extracted from a technology-aided assessment. As an exemplary use-case, the framework is applied to the Virtual Peg Insertion Test (VPIT), a technology-aided assessment of upper limb sensorimotor impairments. The framework builds on a use-case-specific pathophysiological motivation of metrics, models demographic confounds, and evaluates the most important clinimetric properties (discriminant validity, structural validity, reliability, measurement error, learning effects). Applied to 77 metrics of the VPIT collected from 120 neurologically intact and 89 affected individuals, the framework allowed selecting 10 clinically relevant core metrics. These assessed the severity of multiple sensorimotor impairments in a valid, reliable, and informative manner. These metrics provided added clinical value by detecting impairments in neurological subjects that did not show any deficits according to conventional scales, and by covering sensorimotor impairments of the arm and hand with a single assessment. The proposed framework provides a transparent, step-by-step selection procedure based on clinically relevant evidence. This creates an interesting alternative to established selection algorithms that optimize mathematical loss functions and are not always intuitive to retrace. This could help addressing the insufficient clinical integration of digital health metrics. For the VPIT, it allowed establishing validated core metrics, paving the way for their integration into neurorehabilitation trials.
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Affiliation(s)
- Christoph M. Kanzler
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Mike D. Rinderknecht
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Anne Schwarz
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Ilse Lamers
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- Rehabilitation and MS Center, Pelt, Belgium
| | - Cynthia Gagnon
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Québec, Canada
| | - Jeremia P. O. Held
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Peter Feys
- REVAL, Rehabilitation Research Center, BIOMED, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Andreas R. Luft
- Division of Vascular Neurology and Rehabilitation, Department of Neurology, University Hospital and University of Zürich, Zurich, Switzerland
- Cereneo Center for Neurology and Rehabilitation, Vitznau, Switzerland
| | - Roger Gassert
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
| | - Olivier Lambercy
- Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Switzerland
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25
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Schwarz A, Averta G, Veerbeek JM, Luft AR, Held JPO, Valenza G, Biechi A, Bianchi M. A functional analysis-based approach to quantify upper limb impairment level in chronic stroke patients: a pilot study. Annu Int Conf IEEE Eng Med Biol Soc 2020; 2019:4198-4204. [PMID: 31946795 DOI: 10.1109/embc.2019.8857732] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The accurate assessment of upper limb motion impairment induced by stroke - which represents one of the primary causes of disability world-wide - is the first step to successfully monitor and guide patients' recovery. As of today, the majority of the procedures relies on clinical scales, which are mostly based on ordinal scaling, operator-dependent, and subject to floor and ceiling effects. In this work, we intend to overcome these limitations by proposing a novel approach to analytically evaluate the level of pathological movement coupling, based on the quantification of movement complexity. To this goal, we consider the variations of functional Principal Components applied to the reconstruction of joint angle trajectories of the upper limb during daily living task execution, and compared these variations between two conditions, i.e. the affected and non-affected arm. A Dissimilarity Index, which codifies the severity of the upper limb motor impairment with respect to the movement complexity of the non-affected arm, is then proposed. This methodology was validated as a proof of concept upon a set of four chronic stroke subjects with mild to moderate arm and hand impairments. As a first step, we evaluated whether the derived outcomes differentiate between the two conditions upon the whole data-set. Secondly, we exploited this concept to discern between different subjects and impairment levels. Results show that: i) differences in terms of movement variability between the affected and nonaffected upper limb are detectable and ii) different impairment profiles can be characterized for single subjects using the proposed approach. Although provisional, these results are very promising and suggest this approach as a basis ingredient for the definition of a novel, operator-independent, sensitive, intuitive and widely applicable scale for the evaluation of upper limb motion impairment.
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Abstract
Background and Purpose- Assessing upper limb movements poststroke is crucial to monitor and understand sensorimotor recovery. Kinematic assessments are expected to enable a sensitive quantification of movement quality and distinguish between restitution and compensation. The nature and practice of these assessments are highly variable and used without knowledge of their clinimetric properties. This presents a challenge when interpreting and comparing results. The purpose of this review was to summarize the state of the art regarding kinematic upper limb assessments poststroke with respect to the assessment task, measurement system, and performance metrics with their clinimetric properties. Subsequently, we aimed to provide evidence-based recommendations for future applications of upper limb kinematics in stroke recovery research. Methods- A systematic search was conducted in PubMed, Embase, CINAHL, and IEEE Xplore. Studies investigating clinimetric properties of applied metrics were assessed for risk of bias using the Consensus-Based Standards for the Selection of Health Measurement Instruments checklist. The quality of evidence for metrics was determined according to the Grading of Recommendations Assessment, Development, and Evaluation approach. Results- A total of 225 studies (N=6197) using 151 different kinematic metrics were identified and allocated to 5 task and 3 measurement system groups. Thirty studies investigated clinimetrics of 62 metrics: reliability (n=8), measurement error (n=5), convergent validity (n=22), and responsiveness (n=2). The metrics task/movement time, number of movement onsets, number of movement ends, path length ratio, peak velocity, number of velocity peaks, trunk displacement, and shoulder flexion/extension received a sufficient evaluation for one clinimetric property. Conclusions- Studies on kinematic assessments of upper limb sensorimotor function are poorly standardized and rarely investigate clinimetrics in an unbiased manner. Based on the available evidence, recommendations on the assessment task, measurement system, and performance metrics were made with the goal to increase standardization. Further high-quality studies evaluating clinimetric properties are needed to validate kinematic assessments, with the long-term goal to elucidate upper limb sensorimotor recovery poststroke. Clinical Trial Registration- URL: https://www.crd.york.ac.uk/prospero/ . Unique identifier: CRD42017064279.
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Affiliation(s)
- Anne Schwarz
- From the Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (A.S., A.R.L., J.M.V.).,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.S., A.R.L., J.M.V.).,Biomedical Signals and Systems, Technical Medical Centre (TechMed Centre), University of Twente, Enschede, the Netherlands (A.S.)
| | - Christoph M Kanzler
- Department of Health Sciences and Technology, Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, ETH Zurich, Switzerland (C.M.K., O.L.)
| | - Olivier Lambercy
- Department of Health Sciences and Technology, Rehabilitation Engineering Laboratory, Institute of Robotics and Intelligent Systems, ETH Zurich, Switzerland (C.M.K., O.L.)
| | - Andreas R Luft
- From the Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (A.S., A.R.L., J.M.V.).,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.S., A.R.L., J.M.V.)
| | - Janne M Veerbeek
- From the Division of Vascular Neurology and Neurorehabilitation, Department of Neurology, University Hospital Zurich, University of Zurich, Switzerland (A.S., A.R.L., J.M.V.).,cereneo, Center for Neurology and Rehabilitation, Vitznau, Switzerland (A.S., A.R.L., J.M.V.)
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Montenbruck M, Kelle S, Esch S, Andre F, Schwarz A, Korosoglou G, Steen H. 4304Fast-SENC quantifies segmental right ventricular intramyocardial strain to assess subclinical RV dysfunction prior to changes in RV ejection fraction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Right ventricular ejection fraction (RVEF) identifies reduced right-side cardiac function in symptomatic patients. However, alternative metrics are needed to detect subclinical RV dysfunction before cardiac remodeling results in systemic damage. Fast-SENC intramyocardial strain (fSENC) is a unique cardiac magnetic resonance imaging (CMR) modality that measures intramyocardial RV contraction in 1 heartbeat per image plane. This prospective registry compares fSENC and RVEF based on ACC/AHA Heart Failure Stage.
Methods
A single center, prospective registry of MRI scans acquired with a 1.5T scanner were evaluated for conventional CMR diagnostics including RVEF. In addition, fSENC scans were acquired and processed with the MyoStrain software to quantify intramyocardial RV strain. Two short axis scans (basal & midventricular) were used to calculate strain in 6 longitudinal RV segments while two long axis scans (3-chamber & 4-chamber) were used to calculate 5 circumferential RV segments.
CMR and fSENC metrics were compared based on progression of heart failure in which the ACC/AHA Heart Failure stage was determined by CMR findings including LGE in cases in which contrast was injected. HF Stages B and C were separated into different degrees of structural heart disease with “−” representing lower levels and “+” higher levels to provide better delineation of progression of heart dysfunction leading to heart failure.
Results
A total of 977 scans in 779 patients were included in the study. Patients had an average (± stdev) age of 55 (17) yrs and BMI of 26 (5) kg/m2; 48% had arterial hypertension, 12% diabetes mellitus, 33% moderate or severe valvular heart disease, 25% cancer, 7% atrial fibrillation, and 24% coronary artery disease.
Figure 1 shows the relationship between % normal RV myocardium (RV fSENC <−17%) and CMR RVEF in the y-axis versus modified ACC/AHA Heart Failure Stage in the x-axis respectively.
Figure 1
Conclusion
Segmental fSENC detects subclinical RV dysfunction well before changes in RVEF. The ability to directly measure intramyocardial RV strain allows quantification various subclinical right heart diseases, the impact and monitoring of pharmacological therapiesand device interventions on RV function.
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Affiliation(s)
- M Montenbruck
- Marienhospital, Cardiology/Cardiac Imaging, Hamburg, Germany
| | - S Kelle
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - S Esch
- Marien Hospital, Hamburg, Germany
| | - F Andre
- University Hospital of Heidelberg, Heidelberg, Germany
| | - A Schwarz
- Marienhospital, Cardiology/Cardiac Imaging, Hamburg, Germany
| | - G Korosoglou
- Academic Teaching Hospital Weinheim, Department of Internal Medicine/Cardiology and Vascular Medicine, Hamburg, Germany
| | - H Steen
- Marienhospital, Cardiology/Cardiac Imaging, Hamburg, Germany
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Steen H, Montenbruck M, Esch S, Schwarz A, Kelle S, Wuelfing P, Andre F, Korosoglou G. P411Accuracy of cardiotoxicity detection with fast strain-encoded CMR vs echocardiography. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Steen
- Marien Hospital, Hamburg, Germany
| | | | - S Esch
- Marien Hospital, Hamburg, Germany
| | | | - S Kelle
- Charite University Hospital, Berlin, Germany
| | - P Wuelfing
- Mammazentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | - F Andre
- University Hospital of Heidelberg, Heidelberg, Germany
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Steen H, Montenbruck M, Esch S, Schwarz A, Kelle S, Wuelfing P, Andre F, Korosoglou K. P140Fast-SENC quantifies right ventricular intramyocardial strain to assess subclinical RV dysfunction. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez117.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Steen
- Marien hospital, Faculty of University hospital, Hamburg, Germany
| | | | - S Esch
- Marien Hospital, Hamburg, Germany
| | | | - S Kelle
- Charite University Hospital, Berlin, Germany
| | - P Wuelfing
- Mammazentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | - F Andre
- University Hospital of Heidelberg, Heidelberg, Germany
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Schwarz T, Schwarz A. 014 Psoriatic regulatory T cells are impaired in their suppressive activity and respond differently to IL-33. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gessner DK, Schwarz A, Meyer S, Wen G, Most E, Zorn H, Ringseis R, Eder K. Insect Meal as Alternative Protein Source Exerts Pronounced Lipid-Lowering Effects in Hyperlipidemic Obese Zucker Rats. J Nutr 2019; 149:566-577. [PMID: 30726942 DOI: 10.1093/jn/nxy256] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 08/27/2018] [Accepted: 09/07/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Specific dietary proteins exert strong health-related effects compared with casein. OBJECTIVE Herein, the hypothesis was tested using screening and conventional biochemical and molecular biological techniques that protein-rich insect meal compared with casein influences metabolic health in hyperlipidemic rats. METHODS A 4-wk feeding trial with male, 8-wk-old homozygous obese Zucker rats (n = 36) and male, 8-wk-old heterozygous lean Zucker rats (n = 12) was performed. Obese rats were randomly divided into 3 obese groups (OC, OI50, and OI100) of 12 rats each and lean rats served as a lean control group (LC). LC and OC were fed a control diet with 20% casein as protein source, whereas in OI50 and OI100 50% and 100% of the casein, respectively, was replaced isonitrogenously by insect meal from Tenebrio molitor L. All data were analyzed by 1-factor ANOVA, except transcriptomic data which were analyzed by groupwise comparisons with the OC group. RESULTS Transcript profiling revealed a coordinated inhibition by -17% to -521% and -37% to -859% of genes involved in fatty acid, triacylglycerol (TG), and cholesterol biosynthesis in the livers of OI100 and OI50, respectively, compared with OC (P < 0.05). Enzyme activities of fatty acid synthase, glucose-6 phosphate dehydrogenase, and 3-hydroxy-3-methylglutaryl-coenzyme-A reductase in the liver were 100-150% greater in OC compared with LC, but reduced by 50-60% in OI100 compared with OC (P < 0.05), to the same level as in LC. Liver and plasma concentrations of TG and cholesterol were 250-1000%, 30-800%, and 40-600% higher in OC, OI50, and OI100, respectively, than in LC (P < 0.05), but 40-60% and 20-60% lower in OI100 and OI50, respectively, than in group OC (P < 0.05). Plasma and liver concentrations of homocysteine were 20-30% lower in group OI100 than in group OC (P < 0.05). CONCLUSION Insect meal exerts pronounced lipid-lowering effects in hyperlipidemic rats and, thus, might be useful for hyperlipidemic individuals.
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Affiliation(s)
| | - Anne Schwarz
- Institute of Animal Nutrition and Nutrition Physiology
| | - Sandra Meyer
- Institute of Animal Nutrition and Nutrition Physiology
| | - Gaiping Wen
- Institute of Animal Nutrition and Nutrition Physiology
| | - Erika Most
- Institute of Animal Nutrition and Nutrition Physiology
| | - Holger Zorn
- Institute of Food Chemistry and Food Biotechnology, Justus-Liebig-University Giessen, Giessen, Germany
| | | | - Klaus Eder
- Institute of Animal Nutrition and Nutrition Physiology
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Fiss I, Bettag C, Schatlo B, von Eckardstein K, Tsogkas I, Schwarz A, von der Brelie C, Rohde V. Prophylactic enlargement of the thecal sac volume by spinal expansion duroplasty in patients with unresectable malignant intramedullary tumors and metastases prior to radiotherapy. Neurosurg Rev 2018; 43:273-279. [PMID: 30426355 DOI: 10.1007/s10143-018-1051-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/14/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
Unresectable malignant intramedullary tumors and metastases usually require radiotherapy which intensifies spinal cord edema and might result in neurological decline. Spinal expansion duroplasty before radiotherapy enlarges the intrathecal volume and might thus prevent neurological deficits. The study aims to evaluate the clinical course of patients undergoing expansion duroplasty. This retrospective analysis (2007-2016) included all patients with unresectable intramedullary tumors who underwent spinal expansion duroplasty. To assess the degree of preoperative cord enlargement, we calculated the "diameter ratio": diameter of the spinal cord below and above the tumor / diameter of the tumor × 2. The presence of perimedullary cerebrospinal fluid (CSF) at the affected levels was analyzed on the preoperative magnetic resonance imaging (MRI). We recorded the occurrence of neurological deficits, wound breakdown, and CSF fistula. We screened 985 patients, 11 of which were included. Eight patients had an intramedullary metastasis, three patients a spinal malignant glioma. A diameter ratio ≤ 0.8 representing a significant preoperative intramedullary enlargement was seen in 10 cases (90.9%). Postoperative imaging was available in 9 patients, demonstrating successful decompression in 8 of the 9 patients (88.9%). The postoperative course was uneventful in 9 patients (81.8%). Mean overall survival was 13.4 (SD 16.2) months. Spinal expansion duroplasty prior to radiotherapy is a previously undescribed concept. Despite neoadjuvant radiation, no wound breakdown or CSF fistula occurred. In unresectable intramedullary tumors and metastases, spinal expansion duroplasty seems to be a safe procedure with the potential to prevent neurological decline due to radiation-induced cord swelling.
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Affiliation(s)
- Ingo Fiss
- Department of Neurosurgery, Medical Center, Georg August University of Göttingen, Göttingen, Germany.
| | - C Bettag
- Department of Neurosurgery, Medical Center, Georg August University of Göttingen, Göttingen, Germany
| | - B Schatlo
- Department of Neurosurgery, Medical Center, Georg August University of Göttingen, Göttingen, Germany
| | - K von Eckardstein
- Department of Neurosurgery, Medical Center, Georg August University of Göttingen, Göttingen, Germany
| | - I Tsogkas
- Department of Neuroradiology, Medical Center, Georg August University of Göttingen, Göttingen, Germany
| | - A Schwarz
- Department of Neuroradiology, Medical Center, Georg August University of Göttingen, Göttingen, Germany
| | - C von der Brelie
- Department of Neurosurgery, Medical Center, Georg August University of Göttingen, Göttingen, Germany
| | - V Rohde
- Department of Neurosurgery, Medical Center, Georg August University of Göttingen, Göttingen, Germany
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Pérez N, Schwarz A, de Bruijn J. Evaluation of fine organic mixtures for treatment of acid mine drainage in sulfidogenic reactors. Water Sci Technol 2018; 78:1715-1725. [PMID: 30500795 DOI: 10.2166/wst.2018.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The performance of passive biochemical reactors in acid mine drainage (AMD) treatment could be enhanced by using fine organic substrates in new reactor designs, such as diffusive exchange reactors. This work evaluated the effect of fine cellulosic components in organic mixtures and of enrichment with inoculum, on sulfate and metals removal in discontinuous cultures for three types of synthetic AMD. The cellulosic substrates evaluated were sawdust, microcrystalline cellulose, and forestry cellulose fibers, supplemented with cow manure and leaf compost. Using microcrystalline cellulose and forestry cellulose fibers with the less concentrated AMD, high sulfate reduction rates (73 mg/L-d and 58.2 mg/L-d, respectively) were achieved. Correspondingly, iron concentrations were reduced by 69% and 86.6%. Based on their higher sulfate reducing capacity, cellulose fibers obtained as fiber boards from a local kraft pulp mill were selected for treating a synthetic AMD with a high copper concentration (273 mg/L) and pH 4.94. In batch culture, low sulfate reducing activity (13.10 mg/L-d) was only observed at the highest substrate/AMD ratio (0.5:10) tested. Results show that the use of forestry cellulose fibers in reactive mixtures supplemented with inoculum could be an alternative for optimization of diffusive exchange reactors for AMD treatment.
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Affiliation(s)
- N Pérez
- Centro de Recursos Hídricos para la agricultura y Minería (CRHIAM), Universidad de Concepción, Barrio Universitario sn, Concepción, Chile E-mail: ; Departamento de Acuicultura, Universidad Católica del Norte, Facultad de Ciencias del Mar, Larrondo 1281, P.O. Box 117, Coquimbo, Chile and Escuela de Prevención de Riesgos y Medio Ambiente, Facultad de Ciencias del Mar, Universidad Católica del Norte
| | - A Schwarz
- Centro de Recursos Hídricos para la agricultura y Minería (CRHIAM), Universidad de Concepción, Barrio Universitario sn, Concepción, Chile E-mail: ; Departamento de Ingeniería Civil, Universidad de Concepción, Barrio Universitario sn, Concepción, Chile
| | - J de Bruijn
- Facultad de Ingeniería Agrícola, Universidad de Concepción, Avenida Vicente Méndez 595, Chillán, Chile
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Hug PJ, Cap VH, Honegger J, Schüpbach-Regula G, Schwarz A, Bettschart-Wolfensberger R. Optimization of analgesia for piglet castration under isoflurane anaesthesia with parenteral butorphanol, meloxicam or intratesticular lidocaine. SCHWEIZ ARCH TIERH 2018; 160:461-467. [PMID: 29989553 DOI: 10.17236/sat00169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION This blinded prospective study investigated analgesic effects of intramuscular (IM) butorphanol, meloxicam or intratesticular (IT) lidocaine for castration of 7-14 days old piglets under isoflurane anaesthesia. 66 piglets were randomly injected with: meloxicam IM (0.4 mg/kg; group M), butorphanol IM (0.2 mg/kg; group B), or both (group BM) 20 minutes prior to castration, or lidocaine IT (4 mg/kg (group ML4) or 8 mg/kg (group ML8)) together with meloxicam IM (0.4 mg/kg) under anaesthesia with 1.8% end-tidal isoflurane. Heart rate, respiratory rate, mean arterial blood pressure and end-tidal carbon dioxide were recorded. Anaesthesia quality was scored and postoperative behaviour assessed. As butorphanol caused unacceptable side effects, its use was stopped. Group M showed worse anaesthesia quality than ML4 and ML8 (higher incidence of movements: 11/17, 3/18 and 4/17, respectively). There were no significant differences between groups regarding parameters measured during castration. Postoperative behaviour did not differ between groups. For castration of 7-14 days old piglets under isoflurane anaesthesia, IT lidocaine provides an additional side effect free analgesia.
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Affiliation(s)
- P J Hug
- Section Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich
| | - V H Cap
- Section Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich
| | - J Honegger
- Department for Farm Animals, Division of Swine Medicine, Vetsuisse Faculty, University of Zurich
| | - G Schüpbach-Regula
- Veterinary Public Health Institute, Vetsuisse Faculty, University of Bern
| | - A Schwarz
- Section Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich
| | - R Bettschart-Wolfensberger
- Section Anaesthesiology, Department of Clinical Diagnostics and Services, Vetsuisse Faculty, University of Zurich
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Rigamonti S, Bettschart-Wolfensberger R, Schwarz A, Nussbaumer I. [Evaluation of a field-suitable injection anesthesia protocol for the castration of 8 to 14 days old piglets]. SCHWEIZ ARCH TIERH 2018; 160:469-474. [PMID: 29989554 DOI: 10.17236/sat00170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The aim of this study was to find an intramuscularly (IM) injectable anaesthetic combination for 8 to 14-days old piglets, that guarantees a calm induction and sufficient quality of anaesthesia without excitations with a maximum of two hours long lasting recovery. In preliminary dose finding trials, different combinations of -ketamine, azaperone and romifidine were compared. A constant dose of 0.2 mg/kg of butorphanol was added to each combination and all piglets received 0.4 mg/kg meloxicam. Subsequently a dosage algorithm for the main trial was developed. In case of insufficient analgesia, lidocaine 2% (0.25 ml) was injected intratesticular. If two piglets showed an insufficient anaesthetic induction phase, depth of anaesthesia or recovery, the next dosage in the algorithm was tried. With the combination of 3 mg/kg azaperone, 0.2 mg/kg romifidine, 15 mg/kg ketamine and 0.2 mg/kg butorphanol the requirement of a smooth anaesthesia induction, sufficient anaesthesia and a recovery without excitation was fulfilled but the recovery lasted more than 120 minutes.
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Affiliation(s)
| | - R Bettschart-Wolfensberger
- Departement für klinische Diagnostik und Services, Abteilung Anästhesiologie, Vetsuisse-Fakultät, Universität Zürich
| | - A Schwarz
- Departement für klinische Diagnostik und Services, Abteilung Anästhesiologie, Vetsuisse-Fakultät, Universität Zürich
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Schwarz A, Strieth D, Ulber R, Muffler K. Auswirkung von heterotropher und mixotropher Kultivierung auf die EPS-Produktion terrestrischer Cyanobakterien. CHEM-ING-TECH 2018. [DOI: 10.1002/cite.201855312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. Schwarz
- Technische Hochschule Bingen; Fachbereich 1 - Life Sciences & Engineering; Berlinstraße 109 55411 Bingen am Rhein Deutschland
| | - D. Strieth
- Technische Universität Kaiserslautern; Lehrgebiet Bioverfahrenstechnik; Gottlieb-Daimler-Straße 49 67663 Kaiserslautern Deutschland
| | - R. Ulber
- Technische Universität Kaiserslautern; Lehrgebiet Bioverfahrenstechnik; Gottlieb-Daimler-Straße 49 67663 Kaiserslautern Deutschland
| | - K. Muffler
- Technische Hochschule Bingen; Fachbereich 1 - Life Sciences & Engineering; Berlinstraße 109 55411 Bingen am Rhein Deutschland
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Muri B, Schmierer P, Schwarz A, Sigrist N. Hyperfibrinolysis diagnosed with rotational thromboelastometry and treated with tranexamic acid in a dog with acute traumatic coagulopathy. SCHWEIZ ARCH TIERH 2018; 160:227-233. [PMID: 29615381 DOI: 10.17236/sat00155] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION A 4-year old male Australian Cattle Dog involved in a road traffic accident was presented with severe polytrauma to the Small Animal Clinic, University of Zurich. He was presented in hemorrhagic shock, with an initial lactate of 10.3mmol/l and ongoing bleeding from multiple injury sites. Acute traumatic coagulopathy diagnosed with ROTEM within one hour after accident showed marked hypocoagulation and hyperfibrinolysis. Treatment with a total dose of 40mg/kg of tranexamic acid intravenously resulted in successful elimination of hyperfibrinolysis in the following, serially measured ROTEM tracings.
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Affiliation(s)
- B Muri
- Department for Small Animals, Vetsuisse Faculty, University of Zurich
| | - P Schmierer
- Clinic for Small Animal Surgery, Vetsuisse Faculty, University of Zurich
| | - A Schwarz
- Section of Anaesthesiology, Equine Department, Vetsuisse Faculty, University of Zurich
| | - N Sigrist
- Department for Small Animals, Vetsuisse Faculty, University of Zurich
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Schwarz A, Bruhs A, Schwarz T. 016 Deficiency of the G protein-coupled receptor HCA2 alters the phenotype and function of dendritic cells. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Schwarz T, Bruhs A, Schwarz A. 014 The arylhydrocarbon receptor agonist 4-n-nonylphenol switches non-regulatory T cells into a regulatory phenotype. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- J.L. Vanherweghem
- Dept. of Nephrology, Erasme Hospital, University of Brussels, Brussels, Belgium
| | - W. Drukker
- Dept. of Nephrology, St. Lucas Hospital, Amsterdam, The Netherlands
| | - A. Schwarz
- Universitäts Kliniken Steglitz, Freie Universität Berlin, Berlin, FRG
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Berberich R, Kuhlmann L, Zabori S, Schwarz A, Steinsträßer A. Bindung des monoklonalen Antikörpers BW 250/183 an menschliche Granulozyten. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1629602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
ZusammenfassungFür den szintigraphischen Nachweis entzündlicher Herde wird seit einiger Zeit die spezifische Bindung geeigneter monoklonaler Antikörper an menschliche Granulozyten ausgenutzt. Mit dem Antikörper BW 250/183 wurde versucht, die hierbei zugrundeliegende Bindungskinetik aufzuklären. Als wichtigste Voraussetzung für eine spezifische Zellbindung konnte gezeigt werden, daß der Markierungsvorgang die Immunreaktivität nicht beeinflußt. Bindungsstudien ergaben für den Antikörper eine Affinitätskonstante von 2 × 109l/mol. Üblicherweise werden pro Patient 0,25-1,0 mg des 99mTc-markierten Antikörpers eingesetzt. Nach intravenöser Applikation stellte sich bei den beschriebenen Untersuchungen rasch ein Gleichgewichtszustand im Blut ein, bei dem etwa 1/4 der Aktivität in zellgebundener Form vorlag. Der übrige Aktivitätsanteil fand sich in Form des markierten IgG im Plasma und konnte so direkt mit den Granulozyten, die bereits im Entzündungsherd kumuliert waren, reagieren. Auch eine drastische Reduktion der applizierten Antikörpermenge änderte an diesem Gleichgewichtszustand nichts, das Massenwirkungsgesetz scheint hier nicht unmittelbar anwendbar zu sein. Interferenzen mit Plasmabestandteilen können als Ursache für dieses Verhalten ausgeschlossen werden. Appliziert man statt der Antikörper Granulozyten, die in vitro mit dem Antikörper markiert wurden und bei denen der nicht gebundene Antikörperanteil durch Waschschritte entfernt wurde, so stellt sich bereits innerhalb der ersten 10 min ebenfalls dasselbe Bindungsgleichgewicht im Plasma ein. Interessanterweise verlängerte sich die intravasale Verweildauer der Aktivität hierbei deutlich.
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Elbracht T, Jeschke A, Weseloh G, Swoboda B, Kuwert T, Schwarz A. Bone scintigraphy and clinical outcome in rheumatoid gonarthritis. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1625304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
SummaryAim: For evaluation of the effect of radiosynoviorthesis (RSO) on the early and delayed uptake of 99mTc-biphosphonates and its relation to clinical outcome we studied these variables before and after radiosynoviorthesis performed on 41 knees affected by rheumatoid arthritis. Method: Thirty-seven patients with rheumatoid gonarthritis were treated by intraarticular injection with 185 MBq yttrium-90 citrate. In four of them both knees were treated so that 41 therapies were evaluated. On the average 35 days before and 120 days after radiosynoviorthesis, the early and delayed uptake of 99mTc-diphosphonate (DPD) was measured with a planar gamma camera. Early and late DPD uptake was quantified as a ratio between count values derived from rectangular ROIs placed on the knee treated and on the ipsilateral thigh. The severity of clinical symptoms was assessed on two 3-point rating scales averaged. Results: 30 of the 41 cases favorably responded to radiosynovior-thesis. There was a significant correlation between clinical outcome and pretherapeutic early DPD uptake (EDU) (p <0.05), but not between outcome and pretherapeutic late DPD uptake (DDU). In the whole group, EDU decreased in approximately 76% of cases after therapy (p <0.05), DDU in 54% (p >0.05). In 25 of the 30 responders EDU decreased; EDU increased or remained constant in five of the eleven non-responders. The correlation between outcome and the difference in EDU was significant (r = 0.344; p <0.05). There was no such significant relationship between the difference between pre- and posttherapeutic DDU and clinical course. Conclusion: Three-phase bone scintigraphy may contribute to predict and assess the success of radiosynovior-thesis in rheumatoid arthritis of the knee joint.
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Schnetzler C, Hagen R, Schwarz A, Kircher P, Nuss K. Klinische Anwendung der Computertomographie beim Rind. Tierarztl Prax Ausg G Grosstiere Nutztiere 2018. [DOI: 10.1055/s-0038-1623076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungDie Computertomographie liefert mithilfe von Röntgenstrahlen Schnittbilder von Körperregionen. Diese zeigen eine überlagerungsfreie, zweidimensionale Darstellung aller gewünschten Ebenen und ermöglichen auch eine dreidimensionale Rekonstruktion interessierender Körperregionen. Berichte über die Computertomographie beim Rind finden sich nur vereinzelt. Hohe Kosten, medikamentöse Restriktionen und die notwendige Allgemeinanästhesie limitieren die Anwendungen. Indikationen beim Rind sind vor allem Erkrankungen des Kopfes – wie Zahnerkrankungen oder Otitis media – sowie neurologische Erkrankungen, weniger oft Erkrankungen der Wirbelsäule und Gliedmaßen. Bei wertvollen Rindern, bei denen eine operative Therapie geplant ist, kann die Computertomographie Befunde liefern, die für die Durchführung des Eingriffs entscheidend sind. Die computertomographischen Befunde können andererseits auch dazu beitragen, eine ungünstige Prognose zu erkennen und so unnötige Operationen zu vermeiden.
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Schramm E, Schwarz A, Alber H, Alber G. Effects of the multi-compound complex in Corticosal® in 177 horses with PPID in a retrospective veterinary questionnaire analysis in Germany. PFERDEHEILKUNDE 2018. [DOI: 10.21836/pem20180605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bruhs A, Schwarz T, Schwarz A. 325 The short chain fatty acid sodium butyrate attenuates imiquimod-induced psoriasis-like skin inflammation. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.07.520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hohenberger GM, Schwarz A, Hohenberger F, Niernberger T, Krassnig R, Hörlesberger N, Weiglein AH, Matzi V. Evaluation of Monaldi's approach with regard to needle decompression of the tension pneumothorax-A cadaver study. Injury 2017; 48:1888-1894. [PMID: 28602180 DOI: 10.1016/j.injury.2017.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/12/2017] [Accepted: 06/01/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Although needle decompression of tension pneumothorax through the second intercostal space in the midclavicular line (Monaldi's approach) is a life-saving procedure, severe complications have been reported after its implementation. We evaluated the procedure by comparing how it was performed on cadavers by study participants with different training levels. METHODS Six participants including one thoracic surgeon performed bilateral thoracic drainage after Monaldi on 82 torsos. After the thoraces were opened, the distances from the internal thoracic artery (A), the site of the puncture (B) and the midclavicular line (C) were measured bilaterally with reference to the median of the sternum. Further, it was determined whether the participants had correctly identified the second intercostal space. The differences between B-A and C-B were analysed. RESULTS The needle was placed in the second intercostal space in 136 hemithoraces (83%). The thoracic surgeon showed a hit rate of 0% laceration of adjacent vessels. All the other participants had hit rates between 10% and 15%. The interval B-A ranged from 2.88 to 5.06cm in right and from 3.00 to 5.00cm in left hemithoraces. The distance C-B lay between 1.03cm and 1.87cm (right side), and 0.84cm and 2.02cm (left side). CONCLUSION In our collective, the main problem was failure to assess correctly the lateral extension of the clavicle. If this fact is emphasized during training, Monaldi's approach is a safe method for needle decompression of pneumothorax.
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Affiliation(s)
- G M Hohenberger
- Medical University of Graz, Department of Orthopedics and Trauma Surgery, Austria.
| | | | | | - T Niernberger
- State Hospital Hochsteiermark/Leoben, Department for Surgery, Austria
| | - R Krassnig
- Medical University of Graz, Department of Orthopedics and Trauma Surgery, Austria
| | | | | | - V Matzi
- State Hospital Hochsteiermark/Leoben, Department for Surgery, Austria
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Hohenberger GM, Maier MJ, Dolcet C, Weiglein AH, Schwarz A, Matzi V. Sensory nerve supply of the distal radio-ulnar joint with regard to wrist denervation. J Hand Surg Eur Vol 2017; 42:586-591. [PMID: 27852665 DOI: 10.1177/1753193416677699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective of this study was to determine the precise departure points of the articular branches innervating the distal radio-ulnar joint from the anterior and posterior interosseous nerves. The study sample consisted of 116 upper limbs from adult human cadavers. The articular branches were prepared under the dissection microscope to take measurements using the radial styloid process as point of reference. The articular branch departed from the anterior interosseous nerve at a mean distance of 2.9 cm proximal to the styloid for a radius length of 20.5 cm, and 3.7 cm for a radius length of 26.5 cm, respectively. For the posterior interosseous nerve, the departure point was at a mean distance of 3.1 cm (radius length of 20.5 cm) and at 4.0 cm (radius length of 26.5 cm). Apart from a single branch from the posterior interosseous nerve, all articular branches were located distal to the proximal border of the pronator quadratus. Results indicate that wrist denervation from the volar approach, if performed at the proximal border of the pronator quadratus, or from the dorsal approach at a distance of 4.8 cm (for a radius length of 20.5 cm) or 6.2 cm (for a radius length of 26.5 cm) proximal to the radial styloid process, will eliminate the nerve supply to the distal radio-ulnar joint in the majority of cases.
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Affiliation(s)
- G M Hohenberger
- 1 Department of Trauma Surgery, Medical University of Graz, Graz, Austria
| | - M J Maier
- 2 Institute for Statistics and Mathematics, Vienna University of Economics and Business, Vienna, Austria
| | - C Dolcet
- 3 Institute of Anatomy, Medical University of Graz, Graz, Austria
| | - A H Weiglein
- 3 Institute of Anatomy, Medical University of Graz, Graz, Austria
| | - A Schwarz
- 4 AUVA Trauma Hospital Graz, Graz, Austria
| | - V Matzi
- 4 AUVA Trauma Hospital Graz, Graz, Austria
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Müller-Putz GR, Schwarz A, Pereira J, Ofner P. From classic motor imagery to complex movement intention decoding: The noninvasive Graz-BCI approach. Prog Brain Res 2017; 228:39-70. [PMID: 27590965 DOI: 10.1016/bs.pbr.2016.04.017] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In this chapter, we give an overview of the Graz-BCI research, from the classic motor imagery detection to complex movement intentions decoding. We start by describing the classic motor imagery approach, its application in tetraplegic end users, and the significant improvements achieved using coadaptive brain-computer interfaces (BCIs). These strategies have the drawback of not mirroring the way one plans a movement. To achieve a more natural control-and to reduce the training time-the movements decoded by the BCI need to be closely related to the user's intention. Within this natural control, we focus on the kinematic level, where movement direction and hand position or velocity can be decoded from noninvasive recordings. First, we review movement execution decoding studies, where we describe the decoding algorithms, their performance, and associated features. Second, we describe the major findings in movement imagination decoding, where we emphasize the importance of estimating the sources of the discriminative features. Third, we introduce movement target decoding, which could allow the determination of the target without knowing the exact movement-by-movement details. Aside from the kinematic level, we also address the goal level, which contains relevant information on the upcoming action. Focusing on hand-object interaction and action context dependency, we discuss the possible impact of some recent neurophysiological findings in the future of BCI control. Ideally, the goal and the kinematic decoding would allow an appropriate matching of the BCI to the end users' needs, overcoming the limitations of the classic motor imagery approach.
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Affiliation(s)
- G R Müller-Putz
- Graz University of Technology, Institute of Neural Engineering, Graz, Austria.
| | - A Schwarz
- Graz University of Technology, Institute of Neural Engineering, Graz, Austria
| | - J Pereira
- Graz University of Technology, Institute of Neural Engineering, Graz, Austria
| | - P Ofner
- Graz University of Technology, Institute of Neural Engineering, Graz, Austria
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Schwarz T, Krejner A, Mrowietz U, Bruhs A, Schwarz A. 578 Expression of the G protein-coupled receptors GPR109A and GPR43 is downregulated in psoriatic skin. J Invest Dermatol 2017. [DOI: 10.1016/j.jid.2017.02.600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gebhardt V, Mueller-Hansen L, Schwarz A, Bussen D, Weiss C, Schmittner MD. Chloroprocaine 10 mg/ml for low-dose spinal anaesthesia in perianal surgery - a randomised dose finding study. Acta Anaesthesiol Scand 2017; 61:241-249. [PMID: 27892594 DOI: 10.1111/aas.12839] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/20/2016] [Accepted: 11/01/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Low-dose spinal anaesthesia is a safe and reliable anaesthesia technique in outpatient perianal surgery. Regarding its short duration of action and its trend to hyperbaric characteristics, plain chloroprocaine 10 mg/ml seems to be ideal to perform low-dose spinal anaesthesia. The aim of this trial was to determine the optimal dosage of chloroprocaine for this indication. METHODS Hundred and twenty patients undergoing perianal surgery were enrolled and randomly allocated to receive 10, 20 or 30 mg of chloroprocaine 10 mg/ml intrathecally. Patients had to sit upright for at least 10 min after injection. We measured the expansion of sensory and motor block and the times until voiding, walking without assistance and home discharge. RESULTS The expansion of the sensory (P ≤ 0.0059) and the motor block (P ≤ 0.0086) gained with increasing doses. At a dose of 30 mg the incidence of a profound, clinically relevant motor block was significantly higher compared to 10 and 20 mg (P ≤ 0.0004). In the 10 mg group two patients suffered from nociceptive pain due to an incomplete block and five patients announced discomfort during procedure. Doses of 10 and 20 mg led to a significantly earlier discharge compared to 30 mg (P = 0.0003; P = 0.0406). CONCLUSION Plain chloroprocaine 10 mg/ml can successfully be used for low-dose spinal anaesthesia in perianal outpatient surgery. Regarding the unfavourable motor block and later discharge-times in the 30 mg group on the one hand and the block-failures in the 10 mg group on the other, 20 mg can be recommended as the optimal dose.
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Affiliation(s)
- V. Gebhardt
- Department of Anaesthesiology and Surgical Intensive Care Medicine; University Medical Centre Mannheim; Mannheim Germany
| | - L. Mueller-Hansen
- Department of Anaesthesiology and Surgical Intensive Care Medicine; University Medical Centre Mannheim; Mannheim Germany
| | - A. Schwarz
- Department of Anaesthesiology and Surgical Intensive Care Medicine; University Medical Centre Mannheim; Mannheim Germany
| | - D. Bussen
- Centre of Colo-proctology; Mannheim Germany
| | - C. Weiss
- Department of Medical Statistics; University Medical Centre Mannheim; Mannheim Germany
| | - M. D. Schmittner
- Department of Anaesthesiology and Surgical Intensive Care Medicine; University Medical Centre Mannheim; Mannheim Germany
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