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Garis G, Dettmers C, Hildebrandt A, Duning T, Hildebrandt H. Comparing two relaxation procedures to ease fatigue in multiple sclerosis: a single-blind randomized controlled trial. Neurol Sci 2023; 44:4087-4098. [PMID: 37698785 PMCID: PMC10570225 DOI: 10.1007/s10072-023-07042-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/16/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Various relaxation procedures have been proposed to reduce fatigue in multiple sclerosis (MS). However, it is unknown, which type of relaxation has the largest effect on fatigue reduction and on autonomic nervous system (ANS) activity. OBJECTIVE We aimed to compare two biofeedback-supported relaxation exercises: a deep breathing (DB) exercise and progressive muscle relaxation (PMR), which may ameliorate MS fatigue and alter ANS activity. METHODS We performed a single-blind randomized clinical trial, introducing MS patients (n = 34) to the DB or PMR exercise. We first tested cardiovagal integrity, reflected by changes in heart rate variability (HRV) in response to DB. Participants then performed a fatigue-inducing vigilance task, followed by the DB or PMR. State fatigue was recorded consecutively at baseline, after the vigilance task, and after the relaxation exercise, along with HRV reflecting ANS activity. RESULTS Only patients assigned to the PMR group experienced a significant drop in fatigue, whereas both relaxation exercises changed ANS activity. MS patients showed the expected autonomic response during the cardiovagal reflex test. The vigilance task elevated short-term feelings of fatigue and significantly reduced HRV parameters of parasympathetic activity. Trait fatigue was negatively correlated with HRV during the second half of the vigilance task. CONCLUSION PMR alleviates short-term feelings of fatigue in persons with MS. The vigilance task in combination with HRV measurements may be helpful for evaluating relaxation procedures as a treatment of fatigue. Hereby, future studies should ensure longer and more frequent relaxation exercises and focus on patients with weak to moderate fatigue. TRIAL REGISTRATION Trial Registry: DRKS00024358.
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Affiliation(s)
- Guadalupe Garis
- Department of Psychology, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany.
- Department of Neurology, Klinikum Bremen-Ost, 28325, Bremen, Germany.
| | | | - Andrea Hildebrandt
- Department of Psychology, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany
| | - Thomas Duning
- Department of Neurology, Klinikum Bremen-Ost, 28325, Bremen, Germany
| | - Helmut Hildebrandt
- Department of Psychology, Carl Von Ossietzky University Oldenburg, Oldenburg, Germany.
- Department of Neurology, Klinikum Bremen-Ost, 28325, Bremen, Germany.
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Piliavska K, Dantlgraber M, Dettmers C, Jöbges M, Liepert J, Schmidt R. Functional neurological symptoms are a frequent and relevant comorbidity in patients with multiple sclerosis. Front Neurol 2023; 14:1077838. [PMID: 37114221 PMCID: PMC10126263 DOI: 10.3389/fneur.2023.1077838] [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: 10/23/2022] [Accepted: 03/20/2023] [Indexed: 04/29/2023] Open
Abstract
Introduction Functional neurological symptoms (FNS) in multiple sclerosis (MS) have shown to be underinvestigated even though neurological diseases such as MS represent a risk factor for developing FNS. Comorbidity of FNS and MS can produce high personal and social costs since FNS patients have high healthcare utilization costs and a quality of life at least as impaired as in patients with disorders with underlying structural pathology. This study aims to assess comorbid FNS in patients with MS (pwMS) and investigate whether FNS in pwMS are associated with poorer health-related quality of life and work ability. Methods Newly admitted patients (234) with MS were studied during their stay at Kliniken Schmieder, a neurological rehabilitation clinic in Konstanz, Germany. The degree to which the overall clinical picture was explained by MS pathology was rated by neurologists and allied health practitioners on a five-point Likert scale. Additionally, neurologists rated each symptom reported by the patients. Health-related quality of life was assessed using a self-report questionnaire and work ability was assessed using the mean number of hours worked per day and information regarding disability pension as reported by patients. Results In 55.1% of cases, the clinical picture was completely explained by structural pathology due to MS. 17.1% of pwMS presented an overall clinical picture half or less of which could be explained by underlying structural pathology. PwMS with a higher comorbid FNS burden had a lower health-related quality of life and reported fewer working hours per day than pwMS with symptoms explained by structural pathology. Furthermore, pwMS with a full disability pension had a higher comorbid FNS burden than pwMS with no or partial disability pension. Discussion These results show that FNS should be addressed diagnostically and therapeutically since such symptoms are an important comorbidity in MS that is related to poorer health-related quality of life and lower work ability.
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Affiliation(s)
- Katya Piliavska
- Lurija Institute for Rehabilitation Sciences and Health Research, Allensbach, Germany
- *Correspondence: Katya Piliavska,
| | | | - Christian Dettmers
- Lurija Institute for Rehabilitation Sciences and Health Research, Allensbach, Germany
- Kliniken Schmieder Konstanz, Konstanz, Germany
| | - Michael Jöbges
- Lurija Institute for Rehabilitation Sciences and Health Research, Allensbach, Germany
- Kliniken Schmieder Konstanz, Konstanz, Germany
| | - Joachim Liepert
- Lurija Institute for Rehabilitation Sciences and Health Research, Allensbach, Germany
- Kliniken Schmieder Allensbach, Allensbach, Germany
| | - Roger Schmidt
- Lurija Institute for Rehabilitation Sciences and Health Research, Allensbach, Germany
- Klinik für Psychosomatik und Konsiliarpsychiatrie, Kantonsspital, St. Gallen, Switzerland
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Weich C, Dettmers C, Saile R, Schleicher L, Vieten M, Joebges M. Prominent Fatigue but No Motor Fatigability in Non-Hospitalized Patients With Post-COVID-Syndrome. Front Neurol 2022; 13:902502. [PMID: 35847205 PMCID: PMC9283824 DOI: 10.3389/fneur.2022.902502] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Fatigue is a frequent and often disabling symptom in patients with post-COVID syndrome. To better understand and evaluate the symptom of motor fatigue in the context of the post-COVID syndrome, we conducted treadmill walking tests to detect the phenomenon of motor fatigability or to evaluate whether evidence of organic lesions of the motor system could be found, similar to patients with multiple sclerosis. Method Twenty-nine non-hospitalized patients with post-COVID syndrome completed the Fatigue Scale for Motor and Cognitive Function (FSMC) questionnaire to determine the trait component of subjective fatigue before they were tested on a treadmill walking at a moderate speed for up to 60 min or until exhaustion. During the walking test oxygen uptake, ventilation and acceleration data of both feet were collected. To determine motor performance fatigability, the Fatigue Index Kliniken Schmieder (FKS) was calculated using the attractor method. Results The average walking duration was 42.7 ± 18.6 min with 15 subjects stopping the walking test prematurely. The FSMC score revealed a severe cognitive (37.6 ± 8.2) and motor (37.1 ± 7.8) fatigue averaged over all subjects but only two subjects showed an FKS above the normal range (>4), representing performance fatigability. There was no significant correlation between subjective fatigue (FSMC) and FKS as well as walking time. Absolute values of oxygen uptake and ventilation were in the normal range reported in literature (r = 0.9, p < 0.05), although eight subjects did not produce a steady-state behavior. Conclusion Almost all patients with post-COVID syndrome and subjectively severe motor fatigue, did not show motor fatigability nor severe metabolic anomalies. This is argued against organic, permanent damage to the motor system, as is often seen in MS. Many of the patients were - to our and their own surprise - motorically more exertable than expected.
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Affiliation(s)
- Christian Weich
- Department of Sports Science, University of Konstanz, Konstanz, Germany
- Kliniken Schmieder, Konstanz, Germany
| | - Christian Dettmers
- Kliniken Schmieder, Konstanz, Germany
- *Correspondence: Christian Dettmers
| | - Romina Saile
- Department of Sports Science, University of Konstanz, Konstanz, Germany
- Kliniken Schmieder, Konstanz, Germany
| | - Luise Schleicher
- Department of Sports Science, University of Konstanz, Konstanz, Germany
| | - Manfred Vieten
- Department of Sports Science, University of Konstanz, Konstanz, Germany
| | - Michael Joebges
- Department of Sports Science, University of Konstanz, Konstanz, Germany
- Kliniken Schmieder, Konstanz, Germany
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Ghaidar D, Sippel A, Riemann-Lorenz K, Kofahl C, Morrison R, Kleiter I, Schmidt S, Dettmers C, Schulz H, Heesen C. Experiences of persons with multiple sclerosis with rehabilitation-a qualitative interview study. BMC Health Serv Res 2022; 22:770. [PMID: 35690766 PMCID: PMC9188711 DOI: 10.1186/s12913-022-08150-8] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/27/2022] [Indexed: 11/17/2022] Open
Abstract
Background Managing multiple sclerosis (MS) includes different treatment approaches. Rehabilitation is a key strategy in MS for improving functioning, activity and participation. As part of a larger study on overall patient experiences with different treatment approaches, this study aims to give an overview of different patients’ experiences and perspectives on inpatient rehabilitation in MS. Methods We conducted problem-centered interviews in 50 persons with MS in Germany, of whom most had relapsing–remitting MS. We used the maximum variation sampling method during recruitment. Data were analyzed thematically. Results As a result of the analysis, three major themes were identified: 1) factors contributing to the decision-making concerning rehabilitation, 2) experience with the rehabilitation setting, 3) benefits of rehabilitation treatments. The treating physicians’ attitude had a major impact on the decision to either opt for rehabilitation or not. Setting goals prior to rehabilitation was given a high priority. Exchanging experiences with other persons with MS presented a major benefit from rehabilitation while for some being separated from regular daily life resulted in a more ambiguous attitude ranging from appreciation of escaping daily hassles to substantial behavioral change management. Conclusion Patients reported various experiences in the process of decision-making with regard to rehabilitation. Physicians´ advice, goal setting and the selection of the most suitable rehabilitation clinic were considered most relevant. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08150-8.
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Affiliation(s)
- Donya Ghaidar
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.
| | - Anna Sippel
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Karin Riemann-Lorenz
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christopher Kofahl
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | | | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | | | | | - Holger Schulz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany.,Department of Neurology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Broscheid KC, Behrens M, Bilgin-Egner P, Peters A, Dettmers C, Jöbges M, Schega L. Instrumented Assessment of Motor Performance Fatigability During the 6-Min Walk Test in Mildly Affected People With Multiple Sclerosis. Front Neurol 2022; 13:802516. [PMID: 35614920 PMCID: PMC9125148 DOI: 10.3389/fneur.2022.802516] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 03/03/2022] [Indexed: 11/13/2022] Open
Abstract
There are conflicting results regarding the changes in spatio-temporal gait parameters during the 6-min walk test (6MWT) as indicators of gait-related motor performance fatigability (PF) in people with Multiple Sclerosis (pwMS). To further analyze if gait-related motor PF can be quantified using instrumented gait analysis during the 6MWT, we investigated: (i) whether gait parameters recorded during the first or second minute were more stable and thus the better baseline to assess motor PF and (ii) if the minimum toe clearance (MTC) together with “classical” spatio-temporal gait parameters can be used to quantify motor PF in pwMS. Nineteen mildly affected pwMS [12 women/7 men; 47.8 ± 9.0 years; the Expanded Disability Status Scale (EDSS): 2.7 ± 1.0] and 24 healthy controls (HC; 15 women/9 men; 48.8 ± 7.6 years) completed the 6MWT equipped with inertial measurement units. Data were analyzed using the attractor method to compare the stability of gait parameters and, besides “classical” spatio-temporal gait parameters, the MTC was calculated as a potential new marker for motor PF in pwMS as this was shown in healthy older adults. It was found that (i) gait parameters were more stable in the second than in the first minute and (ii) gait-related motor PF could not be detected based on spatio-temporal gait parameters, including the MTC. Descriptive analysis indicated a decrease in MTC variability, which is assumed to be indicative for motor PF, toward the end of the 6MWT in some pwMS. Future studies should investigate gait parameters for the assessment of motor PF in pwMS recorded during more intense and/or longer walking protocols, taking the level of disability into account. Furthermore, using gait parameters recorded in the first minute of the 6MWT as a baseline for the assessment of motor PF should be avoided.
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Affiliation(s)
- Kim-Charline Broscheid
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
- *Correspondence: Kim-Charline Broscheid
| | - Martin Behrens
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Department of Orthopedics, University Medicine Rostock, Rostock, Germany
| | - Patrizia Bilgin-Egner
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | | | | | | | - Lutz Schega
- Health and Physical Activity, Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Broscheid KC, Behrens M, Dettmers C, Jöbges M, Schega L. Effects of a 6-Min Treadmill Walking Test on Dual-Task Gait Performance and Prefrontal Hemodynamics in People With Multiple Sclerosis. Front Neurol 2022; 13:822952. [PMID: 35463151 PMCID: PMC9022001 DOI: 10.3389/fneur.2022.822952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 11/26/2021] [Accepted: 02/14/2022] [Indexed: 11/30/2022] Open
Abstract
Fatigue is one of the most limiting symptoms in people with multiple sclerosis (pwMS) and can be subdivided into trait and state fatigue. Activity-induced state fatigue describes the temporary decline in motor and/or cognitive performance (motor and cognitive performance fatigability, respectively) and/or the increase in the perception of fatigue (perceived fatigability) in response to motor or cognitive tasks. To the best of our knowledge, the effects of a 6-min walk test (6MWT), which was often used to assess motor performance fatigability in pwMS, on motor-cognitive dual-task performance (i.e., walking + arithmetic task) and prefrontal cortex (PFC) hemodynamics are not well-known. This is of importance, since daily activities are often performed as multitasks and a worse dual-task walking performance is associated with an increased risk of falling. Consequently, we investigated the effect of a fast 6MWT (comfort velocity + 15%) performed on a treadmill on motor-cognitive performance fatigability (spatio-temporal gait parameters/accuracy during the arithmetic task) and perceived fatigability measures (rating of perceived exhaustion; RPE) as well as PFC hemodynamics recorded during dual-task walking in pwMS and healthy controls (HCs). Twenty pwMS (48.3 ± 9.0 years; 13 females/7 males; expanded disability status scale 2.7 ± 1.0, first diagnosis 13.8 ± 8.8 years) and 24 HC with similar age and sex (48.6 ± 7.9 years; 17 females/7 males) were included. Only cognitive performance fatigability (increased error rate) during dual-task walking was found after the fast 6MWT on the treadmill in pwMS. However, the changes in gait parameters did not indicate motor performance fatigability, although both the groups reported perceived fatigability (increased RPE) after the fast 6MWT. Moreover, no change in the PFC activation was detected in both groups. Our results suggest that the intensity and/or duration of the fast 6MWT was not sufficient to induce motor performance fatigability in pwMS. These factors should be addressed by future studies on this topic, which should also consider further parameters, e.g., muscular oxygenation and/or myoelectrical activity, to verify that exercise intensity and/or duration was appropriate to induce motor performance fatigability in pwMS.
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Affiliation(s)
- Kim-Charline Broscheid
- Department of Sport Science, Chair of Health and Physical Activity, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
- *Correspondence: Kim-Charline Broscheid
| | - Martin Behrens
- Department of Sport Science, Chair of Health and Physical Activity, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
- Department of Orthopedics, Rostock University Medical Center, Rostock, Germany
| | | | | | - Lutz Schega
- Department of Sport Science, Chair of Health and Physical Activity, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Georgarakis AM, Xiloyannis M, Dettmers C, Joebges M, Wolf P, Riener R. Reaching higher: External scapula assistance can improve upper limb function in humans with irreversible scapula alata. J Neuroeng Rehabil 2021; 18:131. [PMID: 34479574 PMCID: PMC8414749 DOI: 10.1186/s12984-021-00926-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 08/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background Scapular dyskinesis, i.e., the deviant mobility or function of the scapula, hampers upper limb function in daily life. A typical sign of scapular dyskinesis is a scapula alata—a protrusion of the shoulder blade during arm elevation. While some reversible causes of scapula alata can be treated with therapy, other, irreversible causes require invasive surgical interventions. When surgery is not an option, however, severe limitations arise as standard approaches for assisting the scapula in daily life do not exist. The aim of this study was to quantify functional improvements when external, i.e., non-invasive, scapula assistance is provided. Methods The study was designed as a randomized controlled crossover trial. Eight participants with a scapula alata due to muscular dystrophy performed arm elevations in shoulder flexion and abduction while unassisted (baseline), externally assisted by a trained therapist, and externally assisted by a novel, textile-based scapula orthosis. Results With therapist assistance, average arm elevation increased by 17.3° in flexion (p < 0.001, 95% confidence interval of the mean \documentclass[12pt]{minimal}
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\begin{document}$$C{I}_{95\%}=\hspace{0.17em}\left[9.8^\circ , 24.9^\circ \right]$$\end{document}CI95%=9.8∘,24.9∘), and by 11.2° in abduction (p < 0.01, \documentclass[12pt]{minimal}
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\begin{document}$$C{I}_{95\%}=\left[4.7^\circ , 17.7^\circ \right]$$\end{document}CI95%=4.7∘,17.7∘), constituting the potential of external scapula assistance. With orthosis assistance, average arm elevation increased by 6.2° in flexion (\documentclass[12pt]{minimal}
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\begin{document}$$C{I}_{95\%}=\left[0.4^\circ ,11.9^\circ \right]$$\end{document}CI95%=0.4∘,11.9∘) and by 5.8° in abduction (\documentclass[12pt]{minimal}
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\begin{document}$$C{I}_{95\%}=\left[3.0^\circ ,8.5^\circ \right]$$\end{document}CI95%=3.0∘,8.5∘). Remarkably, in three participants, the orthosis was at least as effective as the therapist. Moreover, orthosis assistance reduced average perceived exertion by 1.25 points (Borg Scale) when elevating a filled bottle during a simulated daily living task. Conclusion These findings indicate a large potential for future advancements in orthotics. Already now, the textile-based scapula orthosis presented here is a feasible tool for leveraging the benefits of external scapula assistance when a therapist is unavailable, as encountered in daily life scenarios. Trial Registration ClincalTrials.gov (ID NCT04154098). Registered: November 6th 2019, https://clinicaltrials.gov/ct2/show/NCT04154098?term=scapula+orthosis&draw=2&rank=1 Graphic abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1186/s12984-021-00926-z.
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Affiliation(s)
- Anna-Maria Georgarakis
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zurich, Switzerland. .,Reharobotics Group, Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Zurich, Switzerland.
| | - Michele Xiloyannis
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zurich, Switzerland.,Reharobotics Group, Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Zurich, Switzerland
| | | | | | - Peter Wolf
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zurich, Switzerland
| | - Robert Riener
- Sensory-Motor Systems (SMS) Lab, Institute of Robotics and Intelligent Systems (IRIS), Department of Health Sciences and Technology (D-HEST), ETH Zurich, Zurich, Switzerland.,Reharobotics Group, Spinal Cord Injury Center, Balgrist University Hospital, Medical Faculty, University of Zurich, Zurich, Switzerland
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Dettmers C, Marchione S, Weimer-Jaekel A, Godde B, Joebges M. Cognitive Fatigability, not Fatigue predicts employment status in patients with MS three months after rehabilitation. Mult Scler Relat Disord 2021; 56:103215. [PMID: 34450459 DOI: 10.1016/j.msard.2021.103215] [Citation(s) in RCA: 4] [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] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/01/2021] [Accepted: 08/13/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Fatigue is potentially the most important factor causing unemployment in people with Multiple Sclerosis (PwMS). Widely accepted is a discrimination between fatigue as subjective sensation and fatigability as objective measure of change in performance. The aim of this study was to identify, whether cognitive fatigue or cognitive fatigability is a better predictor for employment status three months after discharge from a neurological rehabilitation center. METHODS 64 PwMS (mean age 48.9, 43 females, mean time since diagnosis 14.7 years, median Expanded Disability Status Scale (EDSS) 3.8), complaining of fatigue and reporting difficulties with their working capacity, participated in a cognitive loading task during inpatient rehabilitation. Reaction time performance was measured using a standardized alertness test (TAP-M). Tonic alertness was measured at 8 a.m., 11 a.m. and 2 p.m. Patients worked on a standardized test battery during the morning and after lunch to induce fatigability. All of them completed the Fatigue Scale for Motor and Cognition (FSMC), a standardized questionnaire to rate the trait component of cognitive and motor fatigue. Their employment status was rated within a standardized interview by phone three months after discharge from the clinic. RESULTS Mean cognitive fatigue according to the FSMC was 38.9 ± 7.4 and mean motor fatigue 41.0 ± 5.6, indicating severe cognitive and motor fatigue. 15 (88%) of 17 patients working fulltime had severe fatigue according to the FSMC. The cognitive subscale of the FSMC ("FSMC cognition") did not correlate (rs = -.084, p = .512) and the motor subscale of the FSMC ("FSMC motor") correlated rather weakly but not significantly (rs= -.220, p = .080) with the employment status. In contrast, there was a significant and medium correlation between alertness at 8 a.m. (alertness1) and employment status (rs = -.304, p = .014). Ordered logistic regression revealed that only alertness1 and the alertness difference between afternoon and noon (alertness difference32) predicted significantly the employment status. The FSMC motor and cognition subscales had no predictive value for employment. CONCLUSION Cognitive fatigability (tonic alertness at 8 a.m. or increase of reaction time during the afternoon) is more adequate to predict employment status in PwMS three months after discharge from the clinic than the subjective sensation of fatigue as determined by the FSMC.
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Affiliation(s)
| | - Sina Marchione
- Kliniken Schmieder, Konstanz, Germany; Psychology and Methods, Jacobs University, Bremen, Germany
| | | | - Benjamin Godde
- Psychology and Methods, Jacobs University, Bremen, Germany
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Pust GEA, Randerath J, Goetzmann L, Weierstall R, Korzinski M, Gold SM, Dettmers C, Ruettner B, Schmidt R. Association of Fatigue Severity With Maladaptive Coping in Multiple Sclerosis: A Data-Driven Psychodynamic Perspective. Front Neurol 2021; 12:652177. [PMID: 33897606 PMCID: PMC8058358 DOI: 10.3389/fneur.2021.652177] [Citation(s) in RCA: 3] [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: 01/11/2021] [Accepted: 03/08/2021] [Indexed: 11/15/2022] Open
Abstract
Fatigue in persons with multiple sclerosis (PwMS) is severely disabling. However, the underlying mechanisms remain incompletely understood. Recent research suggests a link to early childhood adversities and psychological trait variables. In line with these studies, this paper took a psychodynamic perspective on MS-fatigue. It was hypothesized that fatigue could represent a manifestation of maladaptive coping with intense emotions. The schema therapeutic mode model served as a theoretical and empirically validated framework, linking psychodynamic theory and empirical research methods. The study was based on a data set of N = 571 PwMS that has also served as the basis for another publication. Data was collected online. The Schema Mode Inventory was used to quantify regulatory strategies to cope with emotionally stressful experiences. In addition, depressive symptoms (Beck's Depression Inventory - FastScreen), physical disability (Patient Determined Disease Steps), alexithymia (Toronto Alexithymia Scale-26), adverse childhood experiences (Childhood Trauma Questionnaire), and self-reported fatigue (Fatigue Scale for Motor and Cognitive Functions) were assessed. Latent profile analysis revealed three distinct groups of PwMS, based on their coping mode profiles: (1) PwMS with low maladaptive coping, (2) PwMS with avoidant/submissive coping styles, and (3) PwMS with avoidant/overcompensatory coping styles. Multivariate comparisons showed no significant difference in physical disability across the three groups. However, heightened levels of self-reported fatigue and depression symptoms occurred in PwMS with maladaptive coping styles. A path model uncovered that self-reported fatigue was robustly related to physical disability (β = 0.33) and detached/avoidant coping (Detached Protector; β = 0.34). There was no specific relation between any of the maladaptive coping modes and depression symptoms. Detached/avoidant coping was in turn predicted by childhood emotional abuse and neglect. The results indicate that childhood adversity and detached/avoidant coping styles may be associated with variability in MS-fatigue severity: PwMS that resort to detached/avoidant coping in response to negative emotions also tend to report heightened levels of fatigue, although they do not differ in their perceived disability from PwMS with low levels of fatigue and maladaptive coping. A link between MS-fatigue and the psychodynamic traumatic conversion model is discussed. The implications of these findings for therapeutic interventions require further study.
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Affiliation(s)
- Gesa E A Pust
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Jennifer Randerath
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany
| | - Lutz Goetzmann
- Institute of Philosophy, Psychoanalysis and Cultural Studies, Berlin, Germany
| | | | | | - Stefan M Gold
- Institut für Neuroimmunologie und Multiple Sklerose, Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Charité - Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Med. Klinik m.S. Psychosomatik, Campus Benjamin Franklin, Berlin, Germany
| | - Christian Dettmers
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany
| | | | - Roger Schmidt
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany.,Klinik für Psychosomatik und Konsiliarpsychiatrie, Departement Innere Medizin, Kantonsspital St. Gallen, St. Gallen, Switzerland
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10
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Schüler J, Wolff W, Pfeifer J, Rihm R, Reichel J, Rothacher G, Dettmers C. The Role of Perceived Energy and Self-Beliefs for Physical Activity and Sports Activity of Patients With Multiple Sclerosis and Chronic Stroke. Front Psychol 2021; 11:570221. [PMID: 33584409 PMCID: PMC7876439 DOI: 10.3389/fpsyg.2020.570221] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/27/2020] [Indexed: 11/18/2022] Open
Abstract
Physical activity counteracts some of the negative consequences associated with chronic neurological diseases. Here, we describe the levels of physical activity (PA) and sports activity (Sport) in patients with multiple sclerosis (pMS, n = 59) and chronic stroke (pStroke, n = 67) and test compliance with the recommendation for health-promoting physical activity of the World-Health Organization (WHO). Secondly, we tested for differences between the groups of patients, and thirdly, we examined relationships between PA and Sport with psychological indicators of perceived energy (fatigue and vitality) and self-beliefs (self-efficacy and self-control). Psychological constructs were assessed with validated measures from different disciplines in Psychology. A statistical aim was to describe interpretations gained by (non-) parametric Bayesian and Null-Hypothesis-Significance Testing statistics (NHST) on the example of the conducted tests for differences and relationships. Descriptive analyses revealed that pMS and pStroke complied with recommendations of the WHO, but with large variance indicating that patient groups are not homogenous. Tests for differences showed that the PA difference between pMS and pStroke can be attributed to the higher proportion of women in the pMS sample as they engage more in household chores (important part of PA). Tests for relationships showed that for pStroke, vitality, self-control, and self-efficacy were positively related to the level of sports activity. Furthermore, pStroke who were sport active had lower fatigue and higher self-control and self-efficacy scores than sport inactive people. Although they address slightly different questions, the Bayesian and the NHST approach led to similar general conclusions.
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Affiliation(s)
- Julia Schüler
- Department of Sports Science, University of Konstanz, Konstanz, Germany
| | - Wanja Wolff
- Department of Sports Science, University of Konstanz, Konstanz, Germany.,Educational Psychology Lab, University of Bern, Bern, Switzerland
| | - Julian Pfeifer
- Department of Sports Science, University of Konstanz, Konstanz, Germany
| | - Romina Rihm
- Department of Sports Science, University of Konstanz, Konstanz, Germany
| | - Jessica Reichel
- Department of Sports Science, University of Konstanz, Konstanz, Germany
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11
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Dettmers C, Schmidt R, Jöbges M. Fatigue und Fatigability bei Multipler Sklerose –
Leistungsbeurteilung. REHABILITATION 2020; 59:327-329. [PMID: 33285611 DOI: 10.1055/a-1199-2594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Fatigue ist eines der häufigsten Symptome bei Patienten mit Multipler
Sklerose (MS) 1
2. Fatigue kann das Symptom sein, das die berufliche
Leistungsfähigkeit am gravierendsten beeinträchtigt 3
4. Der
Großteil der MS-Patienten ist im erwerbsfähigen Alter. Für
die sozialmedizinische Leistungsbeurteilung ist besonders problematisch, dass es
sich bei der Fatigue um ein subjektives Phänomen handelt, dass nicht
objektiv messbar ist.
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12
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Pust GEA, Dettmers C, Randerath J, Rahn AC, Heesen C, Schmidt R, Gold SM. Fatigue in Multiple Sclerosis Is Associated With Childhood Adversities. Front Psychiatry 2020; 11:811. [PMID: 33005150 PMCID: PMC7485280 DOI: 10.3389/fpsyt.2020.00811] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 07/28/2020] [Indexed: 12/15/2022] Open
Abstract
Fatigue is a common and disabling symptom in patients with Multiple Sclerosis (PwMS). Its pathogenesis, however, is still not fully understood. Potential psychological roots, in particular, have received little attention to date. The present study examined the association of childhood adversities, specific trait characteristics, and MS disease characteristics with fatigue symptoms utilizing path analysis. Five hundred and seventy-one PwMS participated in an online survey. Standardized psychometric tools were applied. The Childhood Trauma Questionnaire (CTQ) served to assess childhood adversities. Trait variables were alexithymia (Toronto Alexithymia Scale; TAS-26) and early maladaptive schemas (Young Schema Questionnaire; YSQ). Current pathology comprised depression (Beck's Depression Inventory FastScreen; BDI-FS) and anxiety symptoms (State-Trait Anxiety Inventory; STAI-state), as well as physical disability (Patient determined Disease Steps; PDDS). The Fatigue Scale for Motor and Cognitive Functions (FSMC) was the primary outcome variable measuring fatigue. PwMS displayed high levels of fatigue and depression (mean FSMC score: 72; mean BDI-II score: 18). The final path model revealed that CTQ emotional neglect and emotional abuse remained as the only significant childhood adversity variables associated with fatigue. There were differential associations for the trait variables and current pathology: TAS-26, the YSQ domain impaired autonomy and performance, as well as all current pathology measures had direct effects on fatigue symptoms, accounting for 28.2% of the FSMC variance. Bayesian estimation also revealed indirect effects from the two CTQ subscales on FSMC. The final model fitted the data well, also after a cross-validation check and after replacing the FSMC with the Chalder Fatigue Questionnaire (CFQ). This study suggests an association psychological factors on fatigue in Multiple Sclerosis. Childhood adversities, as well as specific trait characteristics, seem to be associated with current pathology and fatigue symptoms. The article discusses potential implications and limitations.
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Affiliation(s)
- Gesa E A Pust
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychology, University of Konstanz, Konstanz, Germany.,ZIST, Penzberg, Germany
| | - Christian Dettmers
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany
| | - Jennifer Randerath
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany
| | - Anne C Rahn
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Heesen
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Neurology, University Medical Centre Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Roger Schmidt
- Department of Psychology, University of Konstanz, Konstanz, Germany.,Lurija Institute for Rehabilitation and Health Sciences at the University of Konstanz, Schmieder Foundation for Sciences and Research, Allensbach, Germany.,Klinik für Psychosomatik und Konsiliarpsychiatrie, Departement Innere Medizin, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Stefan M Gold
- Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Campus Benjamin Franklin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Psychosomatic Medicine, Campus Benjamin Franklin, Berlin, Germany
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13
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Hoffmann JA, Bareuther L, Schmidt R, Dettmers C. The relation between memory and decision-making in multiple sclerosis patients. Mult Scler Relat Disord 2020; 37:101433. [PMID: 32173000 DOI: 10.1016/j.msard.2019.101433] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 08/21/2019] [Accepted: 10/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Impairments in long-term and working memory are widespread in Multiple Sclerosis (MS), setting on in early disease stages. These memory impairments may limit patients' ability to take informed and competent medical decisions, too. In healthy populations, memory abilities predict decision quality across a wide range of tasks. These studies suggest that higher working memory capacity supports decisions in cognitively taxing tasks, whereas better semantic memory facilitates decisions in tasks requiring knowledge retrieval. In individuals with MS, previous studies have linked less accurate decisions to memory deficits and reduced executive functioning, too. However, these studies focussed on decisions under risk and did not broadly assess decision making skills. We aimed to fill this gap in a cross-sectional study. METHODS Hundred thirty-seven participants with MS were recruited during their stay in an MS specialized rehabilitation centre. In a first test session, participants completed a standardized test battery for working memory and semantic memory, the inventory for memory diagnostics. In a second test session, participants filled out the Adult Decision Making Competence battery (A-DMC). This version of the A-DMC measured decision making competence on five subscales: Resistance to Framing Effects, Under/Overconfidence, Applying Decision Rules, Consistency in Risk Perception, and Resistance to Sunk Cost Effects. In addition, participants were screened for depression and cognitive fatigue. RESULTS Working memory was impaired in most participants, whereas semantic memory was not impaired. To understand which memory abilities underlie distinct components of decision making in people with MS, we used structural equation modelling. Replicating previous findings in a healthy sample, working memory capacity was associated with the ability to recall semantic knowledge. Participants with lower working memory capacity were less resistant to framing effects and adhered to decision rules less. In contrast, participants with worse semantic memory assessed their own knowledge less accurately, perceived risks less consistently, and made more errors in applying decision rules. Cognitive fatigue and depression unlikely explain these relationships. CONCLUSIONS Taken together, our study suggests that the memory problems, frequently reported in MS patients, may reach out to higher-order cognitive functions, such as decision making skills. Supporting shared decision-making and patient autonomy within MS thus requires to take memory impairments into account and to match the information provided to the patient's memory abilities.
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Affiliation(s)
- Janina A Hoffmann
- Department of Psychology, University of Bath, United Kingdom; Department of Psychology, University of Konstanz, Germany.
| | - Lena Bareuther
- Department of Psychology, University of Konstanz, Germany; Zentralinstitut fuer Seelische Gesundheit, Mannheim, Germany
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14
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Giboin LS, Loewe K, Hassa T, Kramer A, Dettmers C, Spiteri S, Gruber M, Schoenfeld MA. Cortical, subcortical and spinal neural correlates of slackline training-induced balance performance improvements. Neuroimage 2019; 202:116061. [PMID: 31374329 DOI: 10.1016/j.neuroimage.2019.116061] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 11/21/2018] [Revised: 07/17/2019] [Accepted: 07/27/2019] [Indexed: 02/08/2023] Open
Abstract
Humans develop posture and balance control during childhood. Interestingly, adults can also learn to master new complex balance tasks, but the underlying neural mechanisms are not fully understood yet. Here, we combined broad scale brain connectivity fMRI at rest and spinal excitability measurements during movement. Six weeks of slackline training improved the capability to walk on a slackline which was paralleled by functional connectivity changes in brain regions associated with posture and balance control and by task-specific changes of spinal excitability. Importantly, the performance of trainees was not better than control participants in a different, untrained balance task. In conclusion, slackline training induced large-scale neuroplasticity which solely transferred into highly task specific performance improvements.
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Affiliation(s)
- Louis-Solal Giboin
- Sensorimotor Performance Lab, Human Research Performance Centre, University Konstanz, Germany.
| | - Kristian Loewe
- Dept of Experimental Neurology, Otto-von-Guericke-University Magdeburg, Germany; Dept of Computer Science, Otto-von-Guericke-University Magdeburg, Germany
| | - Thomas Hassa
- Lurija Institute, Kliniken Schmieder Allensbach, Germany
| | - Andreas Kramer
- Sensorimotor Performance Lab, Human Research Performance Centre, University Konstanz, Germany
| | - Christian Dettmers
- Lurija Institute, Kliniken Schmieder Allensbach, Germany; Kliniken Schmieder Konstanz, Germany
| | - Stefan Spiteri
- Lurija Institute, Kliniken Schmieder Allensbach, Germany
| | - Markus Gruber
- Sensorimotor Performance Lab, Human Research Performance Centre, University Konstanz, Germany
| | - Mircea Ariel Schoenfeld
- Dept of Experimental Neurology, Otto-von-Guericke-University Magdeburg, Germany; Lurija Institute, Kliniken Schmieder Allensbach, Germany; Dept of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany; Kliniken Schmieder Heidelberg, Germany
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15
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Wolff W, Schüler J, Hofstetter J, Baumann L, Wolf L, Dettmers C. Trait Self-Control Outperforms Trait Fatigue in Predicting MS Patients' Cortical and Perceptual Responses to an Exhaustive Task. Neural Plast 2019; 2019:8527203. [PMID: 31178905 PMCID: PMC6507165 DOI: 10.1155/2019/8527203] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/21/2019] [Accepted: 03/04/2019] [Indexed: 12/18/2022] Open
Abstract
Patients with multiple sclerosis (PwMS) frequently suffer from fatigue, but this debilitating symptom is not yet fully understood. We propose that self-control can be conceptually and mechanistically linked to the fatigue concept and might help explain some of the diversity on how PwMS who suffer from fatigue deal with this symptom. To test this claim, we first assessed how cortical oxygenation and measures of motor and cognitive state fatigue change during a strenuous physical task, and then we tested the predictive validity of trait fatigue and trait self-control in explaining the observed changes. A sample of N = 51 PwMS first completed a test battery to collect trait measures of fatigue and self-control. PwMS then performed an isometric hand contraction task at 10% of their maximum voluntary contraction until exhaustion while we repeatedly assessed ratings of perceived cognitive and motor exertion. In addition, we continuously measured oxygenation of the prefrontal cortex (PFC) using functional near-infrared spectroscopy. Linear mixed-effect models revealed significant increases in perceived motor and cognitive exertion, as well as increases in PFC oxygenation. Hierarchical stepwise regression analyses showed that higher trait self-control predicted a less steep increase in PFC oxygenation and perceived cognitive exertion, while trait fatigue did not predict change in any dependent variable. These results provide preliminary evidence for the suggested link between self-control and fatigue. As self-control can be enhanced with training, this finding possibly has important implications for devising nonpharmacological interventions to help patients deal with symptoms of fatigue.
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Affiliation(s)
- Wanja Wolff
- University of Konstanz, Germany
- University of Bern, Switzerland
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16
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Buchmann I, Dangel M, Finkel L, Jung R, Makhkamova I, Binder A, Dettmers C, Herrmann L, Liepert J, Möller JC, Richter G, Vogler T, Wolf C, Randerath J. Limb apraxia profiles in different clinical samples. Clin Neuropsychol 2019; 34:217-242. [DOI: 10.1080/13854046.2019.1585575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Ilka Buchmann
- University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | | | - Lisa Finkel
- University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
| | | | - Inara Makhkamova
- University of Konstanz, Konstanz, Germany
- Graduate School of Systemic Neurosciences, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Andreas Binder
- Center for Neurological Rehabilitation, Rehaklinik Zihlschlacht, Zihlschlacht, Switzerland
| | - Christian Dettmers
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
- Kliniken Schmieder, Konstanz, Germany
| | - Laura Herrmann
- Klinik für Alterspsychiatrie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
| | - Joachim Liepert
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
- Kliniken Schmieder, Allensbach, Germany
| | - Jens Carsten Möller
- Center for Neurological Rehabilitation, Rehaklinik Zihlschlacht, Zihlschlacht, Switzerland
- Department of Neurology, Philipps University, Marburg, Germany
| | - Gabriel Richter
- Klinik für Alterspsychiatrie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
| | - Tobias Vogler
- Klinik für Alterspsychiatrie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
| | - Caroline Wolf
- Klinik für Alterspsychiatrie, Zentrum für Psychiatrie Reichenau, Reichenau, Germany
| | - Jennifer Randerath
- University of Konstanz, Konstanz, Germany
- Lurija Institute for Rehabilitation Sciences and Health Research at the University of Konstanz, Konstanz, Germany
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17
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Broscheid KC, Dettmers C, Vieten M. Is the Limit-Cycle-Attractor an (almost) invariable characteristic in human walking? Gait Posture 2018; 63:242-247. [PMID: 29778064 DOI: 10.1016/j.gaitpost.2018.05.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Received: 11/14/2017] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Common methods of gait analyses measure step length/width, gait velocity and gait variability to name just a few. Those parameters tend to be changing with fitness and skill of the subjects. But, do stable subject characteristic parameters in walking exist? Does the Limit-Cycle-Attractor qualify as such a parameter?. RESEARCH QUESTION The attractor method is a new approach focusing on the dynamics of human motion. It classifies the fundamental walking pattern by calculating the Limit-Cycle-Attractor and its variability from acceleration data of the feet. Our hypothesis is that the fundamental walking pattern in healthy controls and in people with Multiple Sclerosis (pwMS) is stable, but can be altered through acute interventions or rehabilitation. METHODS For this purpose, two investigations were conducted involving 113 subjects. The short-term stability was tested pre and post a 15 min passive/active MOTOmed (ergometer) session as well as up to 20 min afterwards. The long-term stability was tested over five weeks of rehabilitation once a week in pwMS. The main parameter of interest describes the velocity normalized average difference between two attractors (δM), which is an indicator for the change in movement pattern. RESULTS The Friedman's two-way ANOVA by ranks did not reveal any significant difference in δM. However, the conventional walking tests (6 min.10 m) improved significantly (p < 0.05) during rehabilitation. Contrary to our original hypothesis, the fundamental walking pattern was highly stable against controlled motor-assisted movement initiation via MOTOmed and rehabilitation treatment. Movement characteristics appeared to be independent of the improved fitness as indicated by the enhanced walking speed and distance. SIGNIFICANCE The individual Limit-Cycle-Attractor is extremely robust and might indeed qualify as an (almost) invariable characteristic in human walking. This opens up the possibility to encode the individual walking characteristics. Conditions as Parkinson, Multiple Sclerosis etc., might display disease specific distinctions via the Limit-Cycle-Attractor.
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Affiliation(s)
| | - Christian Dettmers
- Lurija Institute, Kliniken Schmieder Allensbach, Germany; Kliniken Schmieder Konstanz, Germany
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18
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Spiteri S, Hassa T, Claros-Salinas D, Dettmers C, Schoenfeld MA. Neural correlates of effort-dependent and effort-independent cognitive fatigue components in patients with multiple sclerosis. Mult Scler 2017; 25:256-266. [DOI: 10.1177/1352458517743090] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Among patients with multiple sclerosis (MS), fatigue is the most commonly reported symptom. It can be subdivided into an effort-dependent (fatigability) and an effort-independent component (trait-fatigue). Objective: The objective was to disentangle activity changes associated with effort-independent “trait-fatigue” from those associated with effort-dependent fatigability in MS patients. Methods: This study employed behavioral measures and functional magnetic imaging to investigate neural changes in MS patients associated with fatigue. A total of 40 MS patients and 22 age-matched healthy controls performed in a fatigue-inducing N-back task. Effort-independent fatigue was assessed using the Fatigue Scale of Motor and Cognition (FSMC) questionnaire. Results: Effort-independent fatigue was observed to be reflected by activity increases in fronto-striatal-subcortical networks primarily involved in the maintenance of homeostatic processes and in motor and cognitive control. Effort-dependent fatigue (fatigability) leads to activity decreases in attention-related cortical and subcortical networks. Conclusion: These results indicate that effort-independent (fatigue) and effort-dependent fatigue (fatigability) in MS patients have functionally related but fundamentally different neural correlates. Fatigue in MS as a general phenomenon is reflected by complex interactions of activity increases in control networks (effort-independent component) and activity reductions in executive networks (effort-dependent component) of brain areas.
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Affiliation(s)
- Stefan Spiteri
- Lurija Institute for Rehabilitation and Health Sciences, Allensbach, Germany/Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany
| | - Thomas Hassa
- Lurija Institute for Rehabilitation and Health Sciences, Allensbach, Germany/Neurological Rehabilitation Center Kliniken Schmieder, Allensbach, Germany
| | - Dolores Claros-Salinas
- Lurija Institute for Rehabilitation and Health Sciences, Allensbach, Germany/Neurological Rehabilitation Center Kliniken Schmieder, Konstanz, Germany
| | - Christian Dettmers
- Lurija Institute for Rehabilitation and Health Sciences, Allensbach, Germany/Neurological Rehabilitation Center Kliniken Schmieder, Konstanz, Germany/Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Mircea Ariel Schoenfeld
- Lurija Institute for Rehabilitation and Health Sciences, Allensbach, Germany/Neurological Rehabilitation Center Kliniken Schmieder, Heidelberg, Germany/Department of Neurology, Otto-von-Guericke-University, Magdeburg, Germany/Leibniz-Institute for Neurobiology, Magdeburg, Germany
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19
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Marquardt MK, Cohen AL, Gollwitzer PM, Gilbert SJ, Dettmers C. Making if-then plans counteracts learned non-use in stroke patients: A proof-of-principle study. Restor Neurol Neurosci 2017; 35:537-545. [DOI: 10.3233/rnn-170748] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | - Peter M. Gollwitzer
- Department of Psychology, University of Konstanz, Konstanz, Germany
- Department of Psychology, New York University, New York, USA
| | - Sam J. Gilbert
- Institute of Cognitive Neuroscience, University College of London, London, UK
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20
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Schmidt R, Piliavska K, Maier-Ring D, Klaasen van Husen D, Dettmers C. Psychotherapie in der neurologischen Rehabilitation. Akt Neurol 2017. [DOI: 10.1055/s-0043-104525] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ZusammenfassungDem Bedarf angepasste psychotherapeutische Maßnahmen gehören zum unverzichtbaren Behandlungsspektrum der Neurorehabilitation. Allein schon angesichts der großen Häufigkeit komorbider psychischer Störungen, die freilich nicht immer erkannt und angemessen behandelt werden. Die aktuelle Lage ist außerdem gekennzeichnet von einer großen Vielfalt angewendeter Verfahren und einem Mangel an Therapiestudien und gesicherter Evidenz. In diesem Stand der Dinge kommt freilich auch die Vielfalt und Komplexität neurologischer Erkrankungen zum Ausdruck. Zumal bei Vorliegen begleitender psychischer Störungen ist mit von mal zu mal anders akzentuierten Behandlungserfordernissen zu rechnen. Zugleich ist die bei einer Schädigung des ZNS besonders enge Verschränkung leiblicher und seelischer Funktionen zu beachten. Das alles macht eine gleichsam neurologische fundierte, multimodale Psychotherapie erforderlich, die unter Berücksichtigung der unterschiedlichen Behandlungsansätze und Verfahren in eine in sich stimmige, direkt in die weiteren neurorehabilitativen Maßnahmen integrierte Behandlung mündet. Vor diesem Hintergrund soll der Artikel für den nicht tagtäglich psychotherapeutisch arbeitenden Neurologen das Problembewusstsein dafür schärfen, dass psychische Komorbiditäten in der neurologischen Rehabilitation regelhaft vorkommen, entsprechende Behandlungsbedürfnisse aber häufig nicht erfüllt werden – verknüpft mit einem orientierenden Überblick über psychotherapeutische Aufgaben, Verfahren, Entwicklungserfordernisse und Perspektiven.
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Affiliation(s)
- Roger Schmidt
- Kliniken Schmieder Konstanz, Psychotherapeutische Neurologie
- Kliniken Schmieder Allensbach, Lurija Institut für Rehabilitationswissenschaften und Gesundheitsforschung an der Universität Konstanz
| | - Kateryna Piliavska
- Kliniken Schmieder Allensbach, Lurija Institut für Rehabilitationswissenschaften und Gesundheitsforschung an der Universität Konstanz
| | - Dominik Maier-Ring
- Kliniken Schmieder Allensbach, Lurija Institut für Rehabilitationswissenschaften und Gesundheitsforschung an der Universität Konstanz
| | | | - Christian Dettmers
- Kliniken Schmieder Allensbach, Lurija Institut für Rehabilitationswissenschaften und Gesundheitsforschung an der Universität Konstanz
- Kliniken Schmieder Konstanz, Neurologie
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Braun N, Kranczioch C, Liepert J, Dettmers C, Zich C, Büsching I, Debener S. Motor Imagery Impairment in Postacute Stroke Patients. Neural Plast 2017; 2017:4653256. [PMID: 28458926 PMCID: PMC5387846 DOI: 10.1155/2017/4653256] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/14/2017] [Indexed: 01/26/2023] Open
Abstract
Not much is known about how well stroke patients are able to perform motor imagery (MI) and which MI abilities are preserved after stroke. We therefore applied three different MI tasks (one mental chronometry task, one mental rotation task, and one EEG-based neurofeedback task) to a sample of postacute stroke patients (n = 20) and age-matched healthy controls (n = 20) for addressing the following questions: First, which of the MI tasks indicate impairment in stroke patients and are impairments restricted to the paretic side? Second, is there a relationship between MI impairment and sensory loss or paresis severity? And third, do the results of the different MI tasks converge? Significant differences between the stroke and control groups were found in all three MI tasks. However, only the mental chronometry task and EEG analysis revealed paresis side-specific effects. Moreover, sensitivity loss contributed to a performance drop in the mental rotation task. The findings indicate that although MI abilities may be impaired after stroke, most patients retain their ability for MI EEG-based neurofeedback. Interestingly, performance in the different MI measures did not strongly correlate, neither in stroke patients nor in healthy controls. We conclude that one MI measure is not sufficient to fully assess an individual's MI abilities.
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Affiliation(s)
- Niclas Braun
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | - Cornelia Kranczioch
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | | | | | - Catharina Zich
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany
| | | | - Stefan Debener
- Neuropsychology Lab, Department of Psychology, University of Oldenburg, Oldenburg, Germany
- Research Center Neurosensory Science, University of Oldenburg, Oldenburg, Germany
- Cluster of Excellence Hearing4All, University of Oldenburg, Oldenburg, Germany
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Dettmers C, Braun N, Büsching I, Hassa T, Debener S, Liepert J. [Neurofeedback-based motor imagery training for rehabilitation after stroke]. Nervenarzt 2017; 87:1074-1081. [PMID: 27573884 DOI: 10.1007/s00115-016-0185-y] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mental training, including motor observation and motor imagery, has awakened much academic interest. The presumed functional equivalence of motor imagery and motor execution has given hope that mental training could be used for motor rehabilitation after a stroke. Results obtained from randomized controlled trials have shown mixed results. Approximately half of the studies demonstrate positive effects of motor imagery training but the rest do not show an additional benefit. Possible reasons why motor imagery training has so far not become established as a robust therapeutic approach are discussed in detail. Moreover, more recent approaches, such as neurofeedback-based motor imagery or closed-loop systems are presented and the potential importance for motor learning and rehabilitation after a stroke is discussed.
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Affiliation(s)
- C Dettmers
- Kliniken Schmieder Konstanz, Eichhornstr.68, 78464, Konstanz, Deutschland.
| | - N Braun
- Abteilung für Neuropsychologie, Department für Psychologie, Fakultät VI - Medizin und Gesundheitswissenschaften, Universität Oldenburg, Oldenburg, Deutschland
| | - I Büsching
- Kliniken Schmieder Allensbach, Allensbach, Deutschland
| | - T Hassa
- Kliniken Schmieder Allensbach, Allensbach, Deutschland.,Lurija Institut, Konstanz, Deutschland
| | - S Debener
- Abteilung für Neuropsychologie, Department für Psychologie, Fakultät VI - Medizin und Gesundheitswissenschaften, Universität Oldenburg, Oldenburg, Deutschland
| | - J Liepert
- Kliniken Schmieder Allensbach, Allensbach, Deutschland
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Dettmers C, Nedelko V, Schoenfeld MA. Impact of left versus right hemisphere subcortical stroke on the neural processing of action observation and imagery. Restor Neurol Neurosci 2016; 33:701-12. [PMID: 25835557 DOI: 10.3233/rnn-140487] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 11/15/2022]
Abstract
PURPOSE Mental training appears to be an attractive tool in stroke rehabilitation. The objective of this study was to investigate whether any differences in the processing of action observation and imagery might exist between patients with left and right hemisphere subcortical strokes. METHODS Eighteen patients with strictly subcortical stroke (nine right-hemispheric) underwent a functional magnetic resonance imaging (fMRI) study with an experimental paradigm in which motor acts had to be observed and/or imagined from a first person perspective. Changes in hemodynamic activity were measured using fMRI. RESULTS The activity level was found to be higher in the non-lesioned compared to the lesioned hemisphere. Patients with lesions in the left hemisphere had a higher activation level in visual (fusiform and lingual gyri), superior temporal areas and dorsal premotor regions across all performed comparisons than those with right hemisphere lesions. Furthermore they had more vivid imagery experiences and lower scores on the Stroke Impact Scale. CONCLUSIONS Patients with left hemisphere subcortical lesions recruit more cortical regions in the processing of action pictures and videos. This recruitment was further enhanced during imagery. This is most likely related to the fact that the lesion touched the dominant hemisphere.
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Affiliation(s)
- Christian Dettmers
- Kliniken Schmieder Konstanz, Eichhornstraße 68, 78464 Konstanz, Germany.,Lurija Institut für Rehabilitationswissenschaften, Postfach 240, 78476 Allensbach, Germany
| | - Violetta Nedelko
- Lurija Institut für Rehabilitationswissenschaften, Postfach 240, 78476 Allensbach, Germany.,Faculty of Psychology, University of Konstanz, 68467 Konstanz, Germany.,Kliniken Schmieder Allensbach, Zum Tafelholz 8, 76476 Allensbach, Germany
| | - Mircea Ariel Schoenfeld
- Kliniken Schmieder Allensbach, Zum Tafelholz 8, 76476 Allensbach, Germany.,Department of Neurology, University of Magdeburg, Leipzigerstraße 44, 39120 Magdeburg, Germany.,Leibniz Institut für Neurobiologie, Brenneckestraße 6, 39118 Magdeburg, Germany
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Dettmers C, Riegger M, Müller O, Vieten M. Fatigability Assessment Using the Fatigue Index Kliniken Schmieder (FKS) Is Not Compromised by Depression. Health (London) 2016. [DOI: 10.4236/health.2016.814147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Affiliation(s)
| | - John DeLuca
- Neuropsychology and Neuroscience Laboratory, Kessler Foundation , West Orange, NJ , USA
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Lukoschek C, Sterr A, Claros-Salinas D, Gütler R, Dettmers C. Fatigue in Multiple Sclerosis Compared to Stroke. Front Neurol 2015; 6:116. [PMID: 26074869 PMCID: PMC4443716 DOI: 10.3389/fneur.2015.00116] [Citation(s) in RCA: 3] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 05/06/2015] [Indexed: 01/22/2023] Open
Abstract
Objectives Fatigue is typically associated with multiple sclerosis (MS), but recent studies suggest that it is also a problem for patients with stroke. While a direct comparison of fatigue in, e.g., Stroke and MS is desirable, it is presently not easily possible because of different definitions and assessment tools used for the two conditions. In the present study, we therefore assessed fatigue in Stroke and MS using a generic, not disease-specific instrument to allow transdiagnostic comparison. Method A total of 137 patients with MS and 102 patients with chronic stroke completed the SF-36, a generic questionnaire assessing health related quality of life. Fatigue was measured through the vitality scale of the SF-36. The vitality scale consists of two positive items (“lot of energy,” “full of life”) and two negative ones (“worn out,” “tired”). The two negative ones were scaled in reverse order. The vitality scale has been recommended as reciprocal index of fatigue. Results Normalized vitality scores in MS (35.3) and stroke (42.1) were clearly lower than published reference values from the SF-36 in age-matched healthy controls. The sum score of the vitality items was lower in MS than in stroke patients. This difference could not be explained by age, gender, or the Physical Functioning Scale of the SF-36. Both patient groups showed no positive correlation between fatigue and physical functioning. Fatigue – as determined with the vitality scale of the SF-36 – correlated with the estimated working capacity in MS patients, but not in stroke patients. Conclusion These findings confirm high fatigue in MS and stroke patients with higher values in MS. Fatigue has a higher impact on working capacity in MS than in stroke. Fatigue in both patient groups is not a direct consequent of physical functioning/impairment. Vitality score of the SF-36 is a suitable transdiagnostic measure for the assessment of fatigue in stroke and MS.
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Affiliation(s)
| | - Annette Sterr
- University of Surrey , Guildford , UK ; University of Freiburg , Freiburg im Breisgau , Germany ; Department of Neurology, University of São Paulo , São Paulo , Brazil
| | - Dolores Claros-Salinas
- Kliniken Schmieder Konstanz , Konstanz , Germany ; Lurija Institute, Kliniken Schmieder Allensbach , Allensbach , Germany
| | - Rolf Gütler
- Kliniken Schmieder Konstanz , Konstanz , Germany
| | - Christian Dettmers
- Kliniken Schmieder Konstanz , Konstanz , Germany ; Lurija Institute, Kliniken Schmieder Allensbach , Allensbach , Germany ; Department of Psychology, University of Konstanz , Konstanz , Germany
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Abstract
Driving is an important issue for young patients, especially for those whose walking capacity is impaired. Driving might support the patient's social and vocational participation. The question as to whether a patient with multiple sclerosis (MS) is restricted in the ability to drive a car depends on neurological and neuropsychological deficits, self-awareness, insight into deficits and ability to compensate for loss of function. Because of the enormous variability of symptoms in MS the question is highly individualized. A practical driving test under supervision of a driving instructor (possibly accompanied by a neuropsychologist) might be helpful in providing both patient and relatives adequate feedback on driving abilities.
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Affiliation(s)
- J Küst
- MEDIAN-Klinik Burg Landshut, Bernkastel-Kues, Deutschland
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Sehle A, Vieten M, Mündermann A, Dettmers C. Difference in Motor Fatigue between Patients with Stroke and Patients with Multiple Sclerosis: A Pilot Study. Front Neurol 2014; 5:279. [PMID: 25566183 PMCID: PMC4273629 DOI: 10.3389/fneur.2014.00279] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 08/22/2014] [Accepted: 12/08/2014] [Indexed: 11/13/2022] Open
Abstract
Fatigue is often reported in stroke patients. However, it is still unclear if fatigue in stroke patients is more prominent, more frequent or more "typical" than in patients with multiple sclerosis (MS) and if the pathophysiology differs between these two populations. The purpose of this study was to compare motor fatigue and fatigue-induced changes in kinematic gait parameters between stroke patients, MS patients, and healthy persons. Gait parameters at the beginning and end of a treadmill walking test were assessed in 10 stroke patients, 40 MS patients, and 20 healthy subjects. The recently developed Fatigue index Kliniken Schmieder (FKS) based on change of the movement's attractor and its variability was used to measure motor fatigue. Six stroke patients had a pathological FKS. The FKS (indicating the level of motor fatigue) in stroke patients was similar compared to MS patients. Stroke patients had smaller step length, step height and greater step width, circumduction with the right and left leg, and greater sway compared to the other groups at the beginning and at the end of test. A severe walking impairment in stroke patients does not necessarily cause a pathological FKS indicating motor fatigue. Moreover, the FKS can be used as a measure of motor fatigue in stroke and MS and may also be applicable to other diseases.
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Affiliation(s)
- Aida Sehle
- Division of Sport Science, University of Konstanz , Konstanz , Germany ; Lurija Institute, Kliniken Schmieder Allensbach , Allensbach , Germany
| | - Manfred Vieten
- Division of Sport Science, University of Konstanz , Konstanz , Germany
| | - Annegret Mündermann
- Division of Sport Science, University of Konstanz , Konstanz , Germany ; Department of Orthopaedics, University Hospital Basel , Basel , Switzerland
| | - Christian Dettmers
- Lurija Institute, Kliniken Schmieder Allensbach , Allensbach , Germany ; Kliniken Schmieder Konstanz , Konstanz , Germany
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Abstract
OBJECTIVE To explore whether stroke patients exhibit increases in motor excitability during action observation, whether differences exist between the affected and non-affected sides, and between pure motor strokes and predominantly sensory strokes. METHODS In 18 patients (10 pure motor strokes, 8 predominantly sensory strokes, < 6 months after the stroke) transcranial magnetic stimulation was used to test motor excitability while the patients viewed a video showing a hand performing pinch grips. Transcranial magnetic stimulation pulses were applied at 120% of the individual motor threshold at rest, as obtained from the affected hemisphere. Recordings were taken simultaneously from the first dorsal interosseous muscle of both hands. Motor performance was evaluated with the Box and Block Test. RESULTS Transcranial magnetic stimulation-evoked muscle responses obtained from the affected and the unaffected sides were significantly higher during action observation than during rest (p = 0.024 and p = 0.004, respectively). This effect was significantly stronger when measuring the same hand as the one viewed in the video (p = 0.019). No difference was found between motor and sensory strokes. In 11 patients there was an action observation-associated increase in the amplitudes of motor evoked potentials in the affected side. In 15 patients there was an action observation-associated increase in motor evoked potentials amplitudes in the unaffected side. CONCLUSION The results are potentially relevant for the use of action observation as a treatment strategy.
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Affiliation(s)
- Joachim Liepert
- Department of Neurorehabilitation, Kliniken Schmieder, Zum Tafelholz 8, DE-78476 Allensbach, Germany. E-mail:
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Sehle A, Vieten M, Sailer S, Mündermann A, Dettmers C. Objective assessment of motor fatigue in multiple sclerosis: the Fatigue index Kliniken Schmieder (FKS). J Neurol 2014; 261:1752-62. [PMID: 24952620 DOI: 10.1007/s00415-014-7415-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/31/2014] [Accepted: 06/12/2014] [Indexed: 11/28/2022]
Abstract
Fatigue is a common and frequently disabling symptom of multiple sclerosis (MS). The aim of this study was to develop the Fatigue index Kliniken Schmieder (FKS) for detecting motor fatigue in patients with MS using kinematic gait analysis. The FKS relies on the chaos theoretical term "attractor", which, if unchanged, is a necessary and sufficient indicator of a stable dynamical system. We measured the acceleration of the feet at the beginning of and shortly before stopping a treadmill walking task in 20 healthy subjects and 40 patients with multiple sclerosis. The attractor and movement variability were calculated. In the absence of muscular exhaustion a significant difference in the attractor and movement variability between the two time points demonstrates altered motor control indicating fatigue. Subjects were classified using the FKS. All healthy subjects had normal FKS and thus no fatigue. 29 patients with MS were classified into a fatigue group and 11 patients into a non-fatigue group. This classification agreed with the physician's observation and video analyses in up to 97 % of cases. The FKS did not correlate significantly with the overall and motor dimensions of the fatigue questionnaire scores in patients with MS and motor fatigue. The common concept of fatigue as overall subjective sensation of exhaustion can be affected by conditions including depression, sleep disorder and others. FKS constitutes a robust and objective measure of changes in motor performance. Therefore, the FKS allows correct identification of motor fatigue even in cases where common comorbidities mask motor fatigue.
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Affiliation(s)
- Aida Sehle
- Division of Sport Science, University of Konstanz, 78457, Constance, Germany,
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Kuemmel J, Kramer A, Giboin LS, Dettmers C, Gruber M. P572: Treadmill walking until exhaustion reduces isometric maximal voluntary contractions but not electrically evoked muscle twitches in MS patients with fatigue syndrome. Clin Neurophysiol 2014. [DOI: 10.1016/s1388-2457(14)50666-9] [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: 11/16/2022]
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Kramer A, Dettmers C, Gruber M. Exergaming with additional postural demands improves balance and gait in patients with multiple sclerosis as much as conventional balance training and leads to high adherence to home-based balance training. Arch Phys Med Rehabil 2014; 95:1803-9. [PMID: 24823959 DOI: 10.1016/j.apmr.2014.04.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 04/10/2014] [Accepted: 04/21/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the effectiveness of and adherence to an exergame balance training program with additional postural demands in patients with multiple sclerosis (MS). DESIGN Matched controlled trial, assessment of balance before and after different balance training programs, and adherence to home-based balance exercise in the 6 months after the training. SETTING A neurorehabilitation facility and center for MS. PARTICIPANTS Patients with balance problems (N=70) matched into 1 of the training groups according to age as well as balance and gait performance in 4 tests. Nine patients dropped out of the study because of scheduling problems. The mean age of the 61 remaining participants was 47±9 years, and their Expanded Disability Status Scale score was 3±1. INTERVENTIONS Three weeks of (1) conventional balance training (control), (2) exergame training (playing exergames on an unstable platform), or (3) single-task (ST) exercises on the unstable platform. MAIN OUTCOME MEASURES Test scores in balance tests and gait analyses under ST and dual-task (DT) situations. Furthermore, in the 6 months after the rehabilitation training, the frequency and type of balance training were assessed by using questionnaires. RESULTS All 3 groups showed significantly improved balance and gait scores. Only the exergame training group showed significantly higher improvements in the DT condition of the gait test than in the ST condition. Adherence to home-based balance training differed significantly between groups (highest adherence in the exergame training group). CONCLUSIONS Playing exergames on an unstable surface seems to be an effective way to improve balance and gait in patients with MS, especially in DT situations. The integration of exergames seems to have a positive effect on adherence and is thus potentially beneficial for the long-term effectiveness of rehabilitation programs.
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Affiliation(s)
- Andreas Kramer
- Sensorimotor Performance Lab, Department of Sports Sciences, University of Konstanz, Konstanz, Germany.
| | | | - Markus Gruber
- Sensorimotor Performance Lab, Department of Sports Sciences, University of Konstanz, Konstanz, Germany
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Neumann M, Sterr A, Claros-Salinas D, Gütler R, Ulrich R, Dettmers C. Modulation of alertness by sustained cognitive demand in MS as surrogate measure of fatigue and fatigability. J Neurol Sci 2014; 340:178-82. [DOI: 10.1016/j.jns.2014.03.024] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/09/2014] [Accepted: 03/12/2014] [Indexed: 11/15/2022]
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Hilgers C, Mündermann A, Riehle H, Dettmers C. Effects of whole-body vibration training on physical function in patients with multiple sclerosis. NeuroRehabilitation 2013; 32:655-63. [PMID: 23648620 DOI: 10.3233/nre-130888] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this randomized controlled trial was to test the hypothesis that a three-week whole body vibration (WBV) training in addition to a standard rehabilitation program improves walking ability in patients with Multiple Sclerosis (MS). PATIENTS AND METHOD Sixty patients with definite MS were randomly allocated to the intervention or control group. Training sessions were performed three times per week for three weeks. Patients adopted a moderate squat position on a vibration platform. The training sessions comprised series of 3 × 60-sec exercise sets with increasing amplitude between sessions from 1 to 2 mm. During the exercise series, the vibration platform was turned on for the intervention group and switched off for the control group. A mixed factor ANOVA was used to compare sit to stand test, timed up and go test, 10-meter walk test, and 6-min walk test data between patient groups and between baseline and follow-up. RESULTS All outcome measures improved from baseline to follow-up (P < 0.001). The 6-minute walk test showed significantly greater improvements from baseline to follow-up for the intervention than for the control group (P < 0.001). CONCLUSION Determinants of walking ability in patients with MS that are specific to walking endurance tasks are most affected by vibration training designed to improve strength endurance.
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Dettmers C. “Video Therapy”: Promoting Hand Function after Stroke by Action Observation Training – a Pilot Randomized Controlled Trial. ACTA ACUST UNITED AC 2013. [DOI: 10.4172/2329-9096.1000189] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Claros-Salinas D, Dittmer N, Neumann M, Sehle A, Spiteri S, Willmes K, Schoenfeld MA, Dettmers C. Induction of cognitive fatigue in MS patients through cognitive and physical load. Neuropsychol Rehabil 2012; 23:182-201. [PMID: 23153337 DOI: 10.1080/09602011.2012.726925] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The objective of the study was to investigate whether cognitive fatigue in patients with multiple sclerosis (MS) is a spontaneous phenomenon or whether it can be provoked or exacerbated through cognitive effort and motor exercise. Thirty two patients with definite MS and cognitive fatigue according to the Fatigue Scale for Motor and Cognitive Functions (FSMC ≥ 22) performed attention tests (alertness, selective, and divided attention subtests from the TAP test battery for attention performance) twice during rest (baseline), and before and after treadmill training and cognitive load (a standardised battery of neuropsychological tests lasting 2.5 hours). Subjective exhaustion was assessed with a 10-point rating scale. Tonic alertness turned out to be the most sensitive test and showed significantly increased reaction times after treadmill training and after cognitive load. Patients' subjective assessment of exhaustion (10-point rating scale) and the objective test results were discrepant. In contrast, healthy control subjects (N = 20) did not show any decline of performance in the subtest alertness after cognitive or physical load. Data favour the concept that fatigue is induced by physical and mental load. Discrepancies between subjective and objective assessment offer therapeutic options. The common notion of a purely "subjective" lack of physical and/or mental energy should be reconsidered.
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Dettmers C, Benz M, Liepert J, Rockstroh B. Motor imagery in stroke patients, or plegic patients with spinal cord or peripheral diseases. Acta Neurol Scand 2012; 126:238-47. [PMID: 22587653 DOI: 10.1111/j.1600-0404.2012.01680.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES When motor imagery (MI) is impaired in stroke patients, it is not clear, whether this is caused by the central lesion with a disruption of networks or this may be due to inactivity/lack of practice following hemiparesis. To answer this question, we investigated MI in two groups of patients: stroke patients and patients with no central lesion, who suffered high-grade tetraparesis caused by myopathy or spinal muscular atrophy. MATERIALS AND METHODS The first study measured MI in 31 sub-acute and chronic stroke patients with hand paresis. We used self-assessment questionnaires [Kinaesthetic and Visual Imagery Questionnaire (KVIQ), the Vividness of Motor Imagery Questionnaire (VMIQ)] as well as a new chronometric test (mental version and normal/physical version of Box and Block Test). The second study assessed MI in 10 patients without a central lesion, but with severe tetraparesis of peripheral origin. They were incapable of performing the requested task physically. RESULTS MI in patients was better (i) for the third-person (VMIQ(3.P) ) compared to the first-person perspective (VMIQ(1.P) ), (ii) in patients without sensory impairment compared to those with impaired proprioception, (iii) in patients with light paresis compared to severe paresis and (iv) for the non-affected than the affected hand (KVIQ-10). Patients with severe tetraparesis were able to imagine another person's knee bends, but were not capable of imagining themselves performing knee bends. CONCLUSIONS MI may be hampered on the affected side in severely paretic patients, particularly in the presence of impaired proprioception. Remarkably, the second study illustrates that motor experiences shape MI. This confirms the close relationship between MI and movement execution. The study advocates the careful use of test batteries for assessment of MI when investigating mental training in clinical trials. Not all patients might benefit to the same extent from MI training. This is possibly contingent on intact proprioception and preserved MI.
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Affiliation(s)
| | - M. Benz
- Faculty of Psychology; University Konstanz; Konstanz; Germany
| | - J. Liepert
- Kliniken Schmieder Allensbach; Allensbach; Germany
| | - B. Rockstroh
- Faculty of Psychology; University Konstanz; Konstanz; Germany
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Dettmers C, Nedelko V. Einsatz von mentalem Training in der Neurorehabilitation. physioscience 2012. [DOI: 10.1055/s-0031-1299542] [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: 10/28/2022]
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Ertelt D, Hemmelmann C, Dettmers C, Ziegler A, Binkofski F. Observation and execution of upper-limb movements as a tool for rehabilitation of motor deficits in paretic stroke patients: protocol of a randomized clinical trial. BMC Neurol 2012; 12:42. [PMID: 22708612 PMCID: PMC3495666 DOI: 10.1186/1471-2377-12-42] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Accepted: 06/18/2012] [Indexed: 11/10/2022] Open
Abstract
Background Evidence exist that motor observation activates the same cortical motor areas that are involved in the performance of the observed actions. The so called “mirror neuron system” has been proposed to be responsible for this phenomenon. We employ this neural system and its capability to re-enact stored motor representations as a tool for rehabilitating motor control. In our new neurorehabilitative schema (videotherapy) we combine observation of daily actions with concomitant physical training of the observed actions focusing on the upper limbs. Following a pilot study in chronic patients in an ambulatory setting, we currently designed a new multicenter clinical study dedicated to patients in the sub-acute state after stroke using a home-based self-induced training. Within our protocol we assess 1) the capability of action observation to elicit rehabilitational effects in the motor system, and 2) the capacity of this schema to be performed by patients without assistance from a physiotherapist. The results of this study would be of high health and economical relevance. Methods/design A controlled, randomized, multicenter, paralleled, 6 month follow-up study will be conducted on three groups of patients: one group will be given the experimental treatment whereas the other two will participate in control treatments. All patients will undergo their usual rehabilitative treatment beside participation in the study. The experimental condition consists in the observation and immediate imitation of common daily hand and arm actions. The two parallel control groups are a placebo group and a group receiving usual rehabilitation without any trial-related treatment. Trial randomization is provided via external data management. The primary efficacy endpoint is the improvement of the experimental group in a standardized motor function test (Wolf Motor Function Test) relative to control groups. Further assessments refer to subjective and qualitative rehabilitational scores. This study has been reviewed and approved by the ethics committee of Aachen University. Discussion This therapy provides an extension of therapeutic procedures for recovery after stroke and emphasizes the importance of action perception in neurorehabilitation The results of the study could become implemented into the wide physiotherapeutic practice, for example as an ad on and individualized therapy.
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Affiliation(s)
- Denis Ertelt
- Center for Clinical Trials, University of Lübeck, Maria-Goeppert-Straße 1,23562, Lübeck, Germany
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Pommerenke K, Eulitz H, Dettmers C. Retrograde Amnesie nach Resektion eines Medulloblastoms aus dem 4. Ventrikel. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301643] [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: 10/28/2022]
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Giesemann H, Glaser T, Dettmers C. Bewegungsvorstellungstraining nach Schlaganfall - Pilotstudie zur Untersuchung der Akzeptanz. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301557] [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: 10/28/2022]
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Dettmers C. Patient mit unwillkürlicher Imitationsneigung von Handbewegungen nach Schlaganfall. KLIN NEUROPHYSIOL 2012. [DOI: 10.1055/s-0032-1301558] [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: 10/28/2022]
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Hassa T, Schoenfeld MA, Dettmers C, Stoppel CM, Weiller C, Lange R. Neural correlates of somatosensory processing in patients with neglect. Restor Neurol Neurosci 2012; 29:253-63. [PMID: 21697593 DOI: 10.3233/rnn-2011-596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Recent evidence from neuroimaging studies using visual tasks suggests that the right superior parietal cortex plays a pivotal role for the recovery of neglect. Importantly, neglect-related deficits are not limited to the visual system and have a rather multimodal nature. We employed somatosensory stimulation in patients with neglect in order to analyze activity changes in networks that are presumably associated with this condition. METHODS Eleven chronic neglect patients with right hemispherical stroke were investigated with a fMRI paradigm in which the affected and unaffected hand were passively moved. RESULTS Brain activation was correlated with the performance in clinical neglect tests. Significant positive correlations with brain activation were found for the lesion duration, the performance in bells and letter cancellation tests and the line bisection test. These activated areas formed a distributed pattern in the right superior parietal cortex. CONCLUSIONS The results suggest a shared representation of visual and somatosensory networks in the right superior parietal cortex in patients with right hemispherical strokes and neglect. The spatial pattern of activity in the superior parietal cortex points out to a different representation of changes related to lesion duration and neglect.
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Liepert J, Greiner J, Nedelko V, Dettmers C. Reduced upper limb sensation impairs mental chronometry for motor imagery after stroke: clinical and electrophysiological findings. Neurorehabil Neural Repair 2012; 26:470-8. [PMID: 22247502 DOI: 10.1177/1545968311425924] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Motor imagery (MI) is increasingly recognized as a treatment option after stroke, but not all stroke patients are able to perform MI. OBJECTIVE To examine if severe somatosensory deficits would affect MI ability. METHODS The Box and Block Test (BBT) was used to evaluate mental chronometry as 1 component of MI. Two groups of stroke patients and an age-matched healthy control group (CG) were studied. Patient group 1 (n = 10, PG1) had a severe somatosensory impairment on the affected side and PG2 (n = 10) had pure motor strokes. All subjects first performed the BBT in a mental and in a real version. The time needed to move 15 blocks from 1 side of the box to the other was measured. To compare the groups independently of their performance level, a (real performance--MI)/(real performance) ratio was calculated. Corticospinal excitability was measured by transcranial magnetic stimulation at rest and while the subjects performed an imagined pinch grip. RESULTS The CG performed the BBT faster than both patient groups, and PG1 was slower than PG2. MI ability was impaired in PG1 but only for the affected hand. Transcranial magnetic stimulation data showed an abnormally low MI-induced corticospinal excitability increase for the affected hand in PG1, but not in PG2. CONCLUSIONS Severe somatosensory deficits impaired mental chronometry. A controlled study is necessary to clarify if these patients benefit at all from MI as an additional treatment.
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Sehle A, Mündermann A, Starrost K, Sailer S, Becher I, Dettmers C, Vieten M. Objective assessment of motor fatigue in Multiple Sclerosis using kinematic gait analysis: a pilot study. J Neuroeng Rehabil 2011; 8:59. [PMID: 22029427 PMCID: PMC3233503 DOI: 10.1186/1743-0003-8-59] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [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] [Received: 05/11/2011] [Accepted: 10/26/2011] [Indexed: 11/16/2022] Open
Abstract
Background Fatigue is a frequent and serious symptom in patients with Multiple Sclerosis (MS). However, to date there are only few methods for the objective assessment of fatigue. The aim of this study was to develop a method for the objective assessment of motor fatigue using kinematic gait analysis based on treadmill walking and an infrared-guided system. Patients and methods Fourteen patients with clinically definite MS participated in this study. Fatigue was defined according to the Fatigue Scale for Motor and Cognition (FSMC). Patients underwent a physical exertion test involving walking at their pre-determined patient-specific preferred walking speed until they reached complete exhaustion. Gait was recorded using a video camera, a three line-scanning camera system with 11 infrared sensors. Step length, width and height, maximum circumduction with the right and left leg, maximum knee flexion angle of the right and left leg, and trunk sway were measured and compared using paired t-tests (α = 0.005). In addition, variability in these parameters during one-minute intervals was examined. The fatigue index was defined as the number of significant mean and SD changes from the beginning to the end of the exertion test relative to the total number of gait kinematic parameters. Results Clearly, for some patients the mean gait parameters were more affected than the variability of their movements while other patients had smaller differences in mean gait parameters with greater increases in variability. Finally, for other patients gait changes with physical exertion manifested both in changes in mean gait parameters and in altered variability. The variability and fatigue indices correlated significantly with the motoric but not with the cognitive dimension of the FSMC score (R = -0.602 and R = -0.592, respectively; P < 0.026). Conclusions Changes in gait patterns following a physical exertion test in patients with MS suffering from motor fatigue can be measured objectively. These changes in gait patterns can be described using the motor fatigue index and represent an objective measure to assess motor fatigue in MS patients. The results of this study have important implications for the assessments and treatment evaluations of fatigue in MS.
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Affiliation(s)
- Aida Sehle
- Division of Sport Science, Universität Konstanz, Konstanz, Germany
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Dettmers C. [Mental training: learning through motor imagery and imitation]. Sportverletz Sportschaden 2011; 25:135-142. [PMID: 22397020 DOI: 10.1055/s-0031-1291905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Nedelko V, Hassa T, Hamzei F, Weiller C, Binkofski F, Schoenfeld MA, Tüscher O, Dettmers C. Age-independent activation in areas of the mirror neuron system during action observation and action imagery. A fMRI study. Restor Neurol Neurosci 2011; 28:737-47. [PMID: 21209489 DOI: 10.3233/rnn-2010-0542] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Recent studies have found age-related BOLD signal changes in several areas of the human brain. We investigated whether such changes also occur in brain areas involved in the processing of motor action observation and imagery. METHODS Functional magnetic resonance imaging with an experimental paradigm in which motor acts had to be observed and/or imagined from a first person perspective was performed in twenty-six subjects. RESULTS In line with previous work action observation and imagery induced BOLD signal increases in similar areas, predominantly in the premotor and parietal cortex. In contrast to young subjects the elderly displayed a stronger activity in most activated brain areas indicative of compensatory activity for the age-related decline of neural structures. Importantly, activity in the ventrolateral premotor cortex and inferior parietal cortex, seminal areas of the mirror neuron system, did not exhibit activity changes as a function of age. CONCLUSION These findings suggest that activity within the mirror neuron system is not age dependent and provide a neural basis for therapeutical interventions and novel rehabilitation treatments such as video therapy.
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Marquardt MK, Nedelko V, Dettmers C, Gollwitzer PM. Therapy of Armpareses after Stroke by the use of Implementation Intentions. KLIN NEUROPHYSIOL 2010. [DOI: 10.1055/s-0030-1250998] [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: 10/19/2022]
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