Restorative Neurology and Neuroscience - Volume 28, issue 1

Authors: Bötzel, Kai | Kraft, Eduard

Article Type: Research Article

Abstract: Gait difficulties occur early in the course of Parkinson's disease (PD) as well as in generalized dystonia. Deep brain stimulation (DBS) is an effective treatment for patients with PD or dystonia. PD-associated slowness of gait improves dramatically after this procedure. Since not all gait problems can be treated with DBS, it is mandatory to assess the patient's symptoms precisely before an operation can be considered. In advanced stages of PD, postural deficits causing frequent falls are …a major concern and will necessitate other strategies. In dystonia, walking may become possible only after this surgical intervention. After the implantation of DBS electrodes, rehabilitative treatment is necessary to (i) to establish new movement patterns, (ii) preserve an appropriate activity level, and (iii) treat specific disability, which resulted from secondary changes of the musculoskeletal system during pathological muscle tension in dystonia. An integrated multimodal approach, which has been adopted in our institution is presented. Show more

Keywords: Rehabilitation, Parkinson's disease, dystonia

DOI: 10.3233/RNN-2010-0532

Citation: Restorative Neurology and Neuroscience, vol. 28, no. 1, pp. 115-122, 2010

Authors: van Hedel, Hubertus J.A. | Dietz, Volker

Article Type: Research Article

Abstract: Advances in our understanding of the control of locomotion enable us to optimize the rehabilitation of patients with a spinal cord injury (SCI). Based on various animal models, it is generally accepted that central pattern generators (CPG) exists for the rhythmic generation of stepping movements, and that this is also the case in humans. However, in humans supraspinal control is also essential for the performance of locomotion. For regaining locomotor function, incomplete SCI subjects strongly depend …on visual input to compensate for proprioceptive deficits and impaired balance. In addition, they require additional attentional capacity to stand, walk and handle their walking aids. These factors might contribute to their higher risk of falling. During the last decade, task-specific functional training performed by physiotherapists, combined with manual or robotic assisted bodyweight supported treadmill training have improved the regaining of ambulatory function in patients with incomplete SCI. At present, there is no difference in effectiveness between these three types of training. In the future, rehabilitation programs should be optimized to maximally exploit spontaneous and induced neural plasticity, leading to improved ambulation. To evaluate the efficacy of rehabilitation programs and of experimental treatments that might be translated from bench to bedside within the next few years, several objective assessments such as the 10 meter walk test and Walking Index for Spinal Cord Injury have been successfully introduced in the field of SCI rehabilitation. Show more

Keywords: gait, central pattern generator, motor control, physiotherapy, bodyweight supported treadmill training, gait assessments

DOI: 10.3233/RNN-2010-0508

Citation: Restorative Neurology and Neuroscience, vol. 28, no. 1, pp. 123-134, 2010

Authors: Brandt, Thomas | Zwergal, Andreas | Jahn, Klaus | Strupp, Michael

Article Type: Research Article

Abstract: In 2009 the German BMBF (German Ministry of Education and Research) established an Integrated Center for Research and Treatment (IFB^{LMU}) of Vertigo, Balance and Ocular Motor Disorders in Munich. After the 10-year period of funding by the BMBF, it is envisioned that the IFB^{LMU} will continue over the long term with the joint support of the University Hospital, the Medical Faculty, and the Bavarian State. Vertigo is one of the …most common complaints in medicine. Despite its high prevalence, patients with vertigo generally receive either inappropriate or inadequate treatment. This deplorable situation is internationally well known and its causes are multiple: insufficient interdisciplinary cooperation, no standardized diagnostics and therapy, the failure to translate findings of basic science into clinical applications, and the scarcity of clinical multicenter studies. The IFB^{LMU} will constitute a suitable tool with which these structural, clinical, and scientific deficits can be overcome. It will also make possible the establishment of an international interdisciplinary referral center. Munich has become the site of a unique concentration of leading experts on vertigo, balance and ocular motor disorders, both in the clinical and basic sciences. Academic structures have paved the way for the creation of an interdisciplinary horizontal network that also allows structured, vertical academic career paths via the Bachelor's and Master's degree programs in Neuroscience, a Graduate School of Systemic Neurosciences, and the Munich Center for Neurosciences - Brain and Mind. The IFB^{LMU} has the following objectives as regards structure and content: to create an independent patient-oriented clinical research center under the auspices of the Medical Faculty but with autonomous administration and budget; to overcome existing clinical and academic barriers separating the traditional specializations; to establish a standardized interdisciplinary longitudinal and transversal network at one site for the management of patients. This should professionalize both the management and the international recruitment of patients (integrated care, telemedicine); to organize the study infrastructure for prospective multicenter clinical studies as well as to free clinical scientists from administrative tasks; to promote translational research with a focus on the innovative topics of molecular, functional and structural imaging, experimental and clinical pharmacotherapy, clinical research of vertigo and balance disorders, mathematical modelling, interaction between biological and technical systems (robotics), and research on functionality and the quality of life; to offer new attractive educational paths and career images for medical doctors, students of the natural sciences, and engineers in clinical research in order to overcome traditional hierarchical structures. This should promote the principles of efficiency and self-reliance; to supplement the existing excellence with up to eight groups of young scientists and up to eight professorships (tenure track). This should also be seen as an incentive that will attract the best young scientists; to incorporate IFB^{LMU} competence into the existing medical and biological graduate schools. The IFB^{LMU} is a unique center – worldwide. Show more

Keywords: Vertigo, balance, locomotion, ocular motor disorders, institutional profile, integrated clinical center

DOI: 10.3233/RNN-2010-0510

Citation: Restorative Neurology and Neuroscience, vol. 28, no. 1, pp. 135-143, 2010