G.C. Fischer

Cerebral autoregulation during whole-body hypothermia and hyperthermia stimulus

The purpose of the study contained herein was to investigate the effects of old traditional physiotherapeutic treatments on cerebral autoregulation. Treatment consisted of complete body immersion in cold or warm water baths. Fifteen volunteers were investigated by means of transcranial Doppler sonography and a servo-controlled noninvasive device for blood pressure measuring. One group of 8 volunteers (mean age, 27.2+/-3.5 yr; gender, 3 females/5 males) was subjected to cold baths of 22 degrees C for 20 min Another group of 7 volunteers (mean age, 52.1+/-8.5 yr; gender, 4 females/3 males) took hyperthermic baths at rising water temperatures from 36 degrees to 42 degrees C, increased by 1 degree C every 5 min. Each volunteer in both groups underwent autoregulation tests two to four times before, during, and after the thermic bath. Dynamic autoregulation was measured by the response of cerebral blood flow velocity to a transient decrease of the mean arterial blood pressure, induced by rapid deflation of thigh cuffs. The autoregulation index, i.e., a measure of the speed of change of cerebral autoregulation, was used to quantify the response. Further parameters were core temperature, blood pressure (mm Hg) and CO2et. During hypothermic baths, core temperature decreased by 0.3 degrees C (P = 0.001), measured between preliminary phase and the end of the bath; the autoregulation index decreased significantly (P < 0.05) from 5.3 before the bath to 4.25 during the bath. During hyperthermic baths, the autoregulation index increased from 6.0 to 7.5 and 8.9 (P < 0.001), with an increase of core temperature of 0.4 degrees C. The main cerebral autoregulation system is dependent on changes of core temperature, provoked by hypothermic or hyperthermic whole-body thermostimulus. Application of hyperthermic baths increased the autoregulation index, and hypothermic baths decreased the autoregulation index. Further studies are needed to prove the positive effects of thermo-stimulating water applications on cerebral hemodynamics in patients with cerebral diseases.

Geriatrisches Assessment für die hausärztliche Praxis –Ergebnisse einer konzertierten Aktion aus sieben europäischen Ländern

Zusammenfassung Hausärzte versorgen eine zunehmende Anzahl alter Menschen mit ihren komplexen Gesundheitsproblemen. In Studien erweisen sich diese Altersprobleme häufig als unerkannt oder nicht optimal behandelt, sodass der traditionelle auf Patientenanliegen reagierende hausärztliche Behandlungsstil zunehmend hinterfragt wird. Ärzte und Wissenschaftler aus sieben europäischen Ländern formierten sich daher zu einer europäischen konzertierten Aktion, um auszuloten, wie ein präventives geriatrisches Assessment zur Verbesserung der Primärversorgung im Alter beitragen kann. Als Ziele des Projektes „Standard-Assessment für aeltere Menschen in der Primärversorgung” (kurz: STEP) wurden folgende festgelegt: (1) Identifizierung wichtiger präventiver Gesundheitsprobleme im Alter, (2) Darlegung der wissenschaftlichen Evidenz zu den präventiven Maßnahmen, (3) Entwicklung eines Assessmentrahmenprogrammes zur Durchführung in allen europäischen Hausarztpraxen. Nach einem festgelegten methodischen Protokoll wurden 33 Gesundheitsbereiche identifiziert, die sich durch ein hohes Präventions- oder ein verbessertes Therapiepotential auszeichnen und hier in einer Übersicht genauer dargestellt sind. Unter Berücksichtigung von wissenschaftlicher Evidenz, Patientenpräferenzen und realen Praxisbedingungen konnte ein Präventionsprogramm im Alter entwickelt werden, in dem validierte und in der Primärversorgung akzeptierte Assessmentinstrumente Einsatz finden. Das diagnostische Vorgehen wurde algorhythmisch angelegt mit einer kurzen Identifizierungs- und einer sich anschließenden diagnostischen Abklärungsphase. Alle empfohlenen Maßnahmen wurden für den europäischen Gebrauch harmonisiert. Ein evidenz-basiertes präventives Assessmentprogramm soll nicht nur Krankheit, Behinderung und soziale Beeinträchtigungen verhindern bzw. minimieren; es kann auch eine einheitliche europäische Datengrundlage schaffen und so als Steuerungsinstrument zur optimierten Ressourcenallokation beitragen.Summary General practitioners are faced with the complex medical care of an increasing number of older people. Traditional demand led care is not able to provide optimal management for this age group, since it has been shown that many important health problems remain unknown or not optimally treated. Preventive geriatric assessment offers primary health care providers new opportunities to focus their management on the particular health problems of older people. A European concerted action involving seven countries formed to develop a “standard assessment for elderly people in primary care (STEP)”. The aim was threefold: 1) to identify important and preventable health problems in old age, 2) to supply health care planners and providers with scientific evidence of the corresponding preventive procedures, and 3) to initiate a practical assessment framework for use in European primary care practices. Using a strict methodological protocol, 33 health problems were identified that potentially improve health outcomes in preventive programs for older people. A summary of the evidence is given for each of the included health areas. Taking the best available evidence, patients’ preferences, and practice conditions into account, a preventive assessment program was developed containing validated and accepted instruments. The approach is algorithmic with a simple problem identification level and a further diagnostic stage. All recommended procedures are harmonized for common European use. An evidence-based preventive assessment program is expected not only to prevent disease and minimize disability and handicap, but it also offers health care planners a European data set of older peoples’ needs for optimized resource allocation.

Female executives are particularly prone to the sleep-disturbing effect of isolated high-strain jobs: a cross-sectional study in German-speaking executives.

This study assessed the main, curvilinear, interactive and gender‐dependent effects of job demands, job control and social support in the prediction of sleep quality. Participants were 348 male and 76 female executives and managers from Germany, Austria and Switzerland. A multiple regression controlling for age, occupational hierarchy and various health behaviors was computed. On the level of the main effects of the Job–Demand–Control–Support (JDCS) model, the results indicate a sleep‐promoting effect of social support. A significant three‐way interaction of job demands, job control and social support was observed. This interaction confirms the buffering effect of high job control and high social support on high job demands. Further, this three‐way interaction of the JDCS dimensions is moderated by gender as indicated by a significant four‐way interaction. The directions of the significant interactions suggest that female executives are especially prone to react with impaired sleep quality when exposed to isolated high‐strain jobs. The study seems to imply that the JDCS model is a suitable framework for the prediction of sleep quality among executives and managers. The results suggest that the JDCS model might contribute to a better understanding of the higher prevalence of poor sleep amongst female executives. Further, the results imply that high job control and high social support might help executives to maintain good sleep quality despite experiencing high job demands.

[Early diagnosis and early treatment of cognitive disorders: a study of geriatric screening of an unselected patient population in general practice].

Zusammenfassung Diese Studie widmet sich der Fragestellung, ob sich ein Früherkennungsprogramm für kognitive Störungen lohnt. In 67 Allgemeinpraxen aus dem hannoverschen und Leipziger Raum wurden 446 ältere Patienten untersucht, wobei 4250 medizinische, 374 psychiatrische und 528 soziale Probleme festgestellt wurden. Die meisten psychischen Störungen der ambulanten Patienten waren den Ärzten unbekannt. Kognitive Störungen waren mit einem schlechten Gesundheitszustand, kardiovaskulären Krankheiten, Gewichtsverlust und Behinderung in den instrumentellen Verrichtungen assoziiert. Eine Früherkennung von Demenzkrankheiten wird im Rahmen eines umfassenden “Gesundheitschecks” gut akzeptiert und eröffnet Hausärzten neue prognostische und therapeutische Möglichkeiten.Summary To investigate the feasibility of early assessment of preventable disabilities in primary care, we developed a geriatric preventive screening examination with various indicators of physical, emotional, and social functions as well as laboratory exams. Cognitive impairment was measured by the modified MMSE. Severe cases of dementia, who would deserve home visits were excluded. Results of the assessment procedure in 446 patients aged 70 and over (71.5 % females) were compared to ratings of general practioners (n = 67). In these patients we found 4250 medical, 374 psychiatric, and 528 social problems. 45.4 % of medical, 61.8 % of psychiatric, and 56.8 % of social problems where hitherto unknown to the GPs. The prevalence of cognitive impairment was 4.6 % according to GPs diagnosis and 21 % according to the MMSE. The sensitivity of GPs diagnosis was 14 %, the specifity 98 %, and the overall agreement measured by kappa was 0.17. There were significant (p < 0.05) associations of cognitive impairment with poor health, vascular disease, syncope, weight loss, previous hospitalization, depression, and ADL and IADL-items. Hypertension, or pathological thyroid function, occurred more frequently in the cognitively impaired (p > 0.05). Only 19.5 % of dementia cases had severe functional loss, which substantiates our hypothesis that mild dementia was studied. Of all cases with newly identified cognitive impairment (n = 83 of 446 patients), three (3.6 %) had reversible disorder such as depression (n = 1), drug toxicity (n = 2) 3 (3.6 %) received counseling, and 5 (6 %) further diagnostic assessment or treatment. One (1.2 %) patient did not accept any treatment. In the remainder of 71 patients (85.5 %), the GPs adopted a wait and see strategy with no intervention. In conclusion, memory deficits seem to be underdiagnosed in general practice despite much treatable comorbidity or social problems, and some reversible conditions such as depression and drug adverse effects.

External stimuli in the form of vibratory massage after heart or lung transplantation.

Manual vibratory massage is part of the preventive physiotherapeutic activities performed in intensive care units. The vibratory massage can be performed manually or as electrovibratory massage. The manual massage is a fast rhythmical vibration performed by the arm and shoulder muscles of the masseur and transferred to the patients thorax by the hand. The hand of the masseur has to achieve a tremor with a frequency of 8 to 11 tremors/s. The aim of the pilot study was to examine the influence of manual vibratory massage on the pulmonary function of postoperative patients who were receiving mechanical ventilation, with special interest being focused on pulmonary ventilation and perfusion and cerebral blood flow velocity. Manual vibratory massage was performed postoperatively in the intensive care unit on eight patients: three patients had undergone heart transplantation, three had undergone lung transplantation, and two had undergone coronary artery bypass grafting (mean age, 53.6+/-8 yr). With the aid of continuous monitoring, we examined the changes of the respiration parameters and the cerebral blood flow velocity (measured by transcranial Doppler sonography). The vibratory massage was performed with a frequency of 8 to 10 vibrations/s for 15 min, 7.5 min on each side of the thorax, starting from the lower costal arch and progressing to the upper thoracic aperture. For 10 min before, during, and 10 min after the massage, the parameters of peripheral oxygen saturation, central venous pressure, mean arterial pressure, heart rate, lung resistance and compliance, tidal volume, respiration rate, and cerebral blood flow velocity were recorded at 2-min intervals. Moreover, before and after vibratory massage, arterial blood gases were determined. In four of the eight patients, it was possible to determine pulmonary arterial pressure, pulmonary capillary wedge pressure, as well as pulmonary vascular resistance. During the vibratory massage, we could prove a significant increase of the mean tidal volume by 30% (P = 0.008). The percutaneous oxygen saturation significantly increased also, from 92 to 93.6% (P = 0.002). Central venous pressure significantly decreased by 11% (P = 0.04), and pulmonary vessel resistance was reduced by 18.3% (P = 0.001). The pulmonary resistance decreased from 10.5 to 9.2 H2O/l/s (P < 0.05) by the end of the observation period. Cerebral blood flow velocity showed no significant change. Vibratory massage seems to improve pulmonary mechanism and perfusion, thus, reducing ventilation perfusion mismatch and increasing oxygen saturation.

Veränderung kognitiver Hirnleistungen im Alter durch Kneipp-Anwendungen

Changes of Cognitive Brain Functions in the Elderly by Kneipp Therapy Introduction: Pharmacological and nonpharmacological treatment of brain syndrome is multifarious. Until now, plain external applications of physical stimuli, as used daily in geriatric care, were not explored regarding their influence on cognitive brain function.The aim of this randomized cross-over study was to examine the influence of dermatoreceptive stimuli on cognitive brain function of healty geriatric volunteers. Methods: 24 healthy volunteers (23 women, 1 man) were randomized into 2 groups (cross-over design). Group A (mean age ± SD: 68.8 ± 6.2 years) was treated according to the following regime: at first a 10–12 °C cold stimulus for 10 s (a so-called Kneipp face shower) and afterwards a cold wet pack of 10–12 °C at the neck for 1 min. Group B (age 69.8 ± 5.3 years) was subjected to an identical procedure but with warm thermoindifferent temperatures of 34–36 °C. After 1 week the two groups were interchanged. The parameters of interest were the critical flicker frequency (CFF) and the latencies of the event-related P300 potentials of the visually evoked potentials (VEP), which can be considered the electroencephalographic substrate of the cognitive functional ability. The CFFs and the P300 latencies and amplitudes were measured directly before and 10 min after the application of the above-mentioned stimuli. Furthermore, the CFFs were recorded a second and third time 30 and 60 min later. Results: Following application of cold-water stimuli, the CFF increased from (mean ± SE) 32.55 ± 0.44 s-1 to 33.06 ± 0.44 s-1 (p = 0.003) 10 min after the stimulus. 30 min later the CFF was still elevated at 32.95 ± 0.47 s-1 (p = 0.043). The P300 latencies decreased by 4.8% (p < 0.001) after cold-water application from 266.5 ± 5.28 to 253.7 ± 4.22 ms. After warm stimuli they increased from 258.69 ± 3.71 to 266.17 ± 5.03 ms (p = 0.01). The P300 amplitudes were elevated by 5% only with the cold stimuli (p = 0.004). Conclusion: Cold water applied locally to face and neck region is able to provoke significant improvements of cognitive abilities.

Metaphorische Aspekte der Misteltherapie im Patientenerleben – eine qualitative Studie

Metaphorical Aspects of Mistletoe Therapy in Patients’ Experiences – a Qualitative Study Objective: Mistletoe therapy is an item of research because of its immunological features. Nevertheless, mistletoe should be also an item of research because of its semiotics. Long before R. Steiner proposed mistletoe as an anticancer drug, this plant seemed to have its meaning not by pharmacodynamics but by pharmacosemiotics and magic. Thus, metaphorical aspects of mistletoe therapy should be described by processing the transcript and paintings from a therapeutic group session of cancer patients. Especially the relation between individually and historically coded metaphors should be looked at. Material and Methods: Sample of this qualitative study is the transcript of a therapeutic session of 12 female malignoma patients getting mistletoe infusions (Isorel(r)) since 1.5 years in a general practitioners’ practice. Sequential coding of the transcript, inventory of themes, and structural hypothesis are the first steps. The structural hypothesis is triangulated by a textual corpus containing anthroposophic and ethnographic material; then a grounded theory is made. Results: The material is divided. On the one hand, there is a huge amount of historically coded, stereotypic metaphors (sun, cancer, ritual). On the other hand, ‘ritual’ seems not only a stereotypic metaphor but also a container of individually coded metaphors concerning body experiences (proprioceptive etc.). Metaphors from anthroposophy are rare – the metaphors seem to stem from a deeper level of ethnographic sources. The whole session has a polyphone narrative structure. Categories of semiotics such as icon, index and symbol are only by the context of interaction a suitable description for mistletoe’s metaphoric function. Conclusions: Problems of bias (denominator problem, valid but not reliable) are discussed, and a proposal is made for further forms of generalization of the results (semantic differentials). Moreover, it has to be asked if different preparations of mistletoe (e.g. lectine standard, draft from planta tota) make different halos of metaphors.

Zerebrale Hämodynamik während der Implantation von Kardioverter-Defibrillator-Systemen

Zusammenfassung□ GrundproblematikBei der Implantation von automatischen implantierbaren Kardioverter-Defibrillatoren (ICD) muß zur Ermittlung der Funktion und der optimalen Reizschwelle Kammerflimmern induziert werden, das einen Kreislaufstillstand und somit auch ein Sistieren der Hirndurchblutung verursacht. Ziel der vorliegenden Studie war es, bei induziertem Kammerflimmern die Veränderungen der zerebralen Blutflußgeschwindigkeit (CBFV(MCA)) in Abhängigkeit von der Länge der Fibrillationszeit und der Ausgangshöhe der CBFV(MCA) zu untersuchen.□ Patienten und Methodik60 induzierte Episoden von Kammerflimmern wurden bei neun Patienten (53,5±8 Jahre alt) während der ICD-Implantation untersucht. Zusätzlich zum anästhesiologischen Monitoring wurde zur Messung der zerebralen Blutflußgeschwindigkeit die transkranielle Doppler-Sonographie (TCD) in der Arteria cerebri media (MCA) eingesetzt. Die Dauer der Fibrillation sowie die Höhe und Dauer der CBFV(MCA)-Erhöhung in der postdefibrillatorischen Phase wurde einer Korrelationsrechnung und linearen Regression unterzogen. Außerdem wurde untersucht, ob systematische Unterschiede zwischen den verschiedenen Episoden eines Patienten bestehen (Zeittrend), wozu jeweils fünf aufeinanderfolgende Episoden verglichen wurden.□ ErgebnisseWir fanden bei allen Episoden in der postdefibrillatorischen Phase eine Hyperperfusion, das heißt ein Zeitintervall, in dem die Meßwerte der CBFV über dem vor der Fibrillation gemessenen Ausgangswert lagen. Für die Hyperperfusionsdauer ergab sich eine signifikante Abhängigkeit von der Fibrillationszeit (r=0,57; p<0,001). Die Regressionsgleichung lautet: Hyperperfusionsdauer=11,1+1,22×Fibrillationszeit. Die Hyperperfusionshöhe, das heißt die maximale CBFV nach Defibrillation, steigt mit der CBFV(MCA) vor der Fibrillation signifikant an (r=0,88; p<0,001), wobei die Regressionsgleichung lautet: Hyperperfusionshöhe=6,11+1,22×CBFV vor Fibrillation. Die Hyperperfusionsdauer wird nicht von der maximalen CBFV(MCA) nach der Defibrillation beeinflußt (r=0,08; p=0,52). Es ergaben sich keine signifikanten Unterschiede zwischen den verschiedenen Episoden eines Patienten hinsichtlich der Hyperperfusionsdauer und der maximalen CBFV nach Defibrillation.□ SchlußfolgerungNach einer induzierten ventrikulären Fibrillation ist immer eine reaktive zerebrale Hyperperfusion zu erwarten. Die Höhe der CBFV nach Defibrillation ist von der Höhe der CBFV vor der Fibrillation abhängig und verhält sich annähernd proportional zu dieser. Die Hyperperfusionsdauer (im Mittel 25,8±10,4 s) zeigt bei den von uns gemessenen Fibrillationszeiten (12±4,8 s) eine lineare Abhängigkeit von der Fibrillationsdauer. Dies gibt einen Hinweis darauf, daß es sich hier um Fibrillationszeiten handelt, bei denen sich die zerebrale Autoregulation und andere zerebrale Regulationsmechanismen reaktiv kompensierend auf die zerebrale Blutflußgeschwindigkeit auswirken. Ob der Hirnstoffwechsel ein ähnliches Verhalten zeigt wie die CBFV, ist Gegenstand weiterer Untersuchungen.Abstract□ ObjectiveDuring ICD-implantation it is necessary to prove the function and to determine the optimal threshold by means of induced ventricular fibrillation (VF). Provoked cardiac arrests cause a circulatory stop of the cerebral perfusion. Our aim was to examine the changes of cerebral blood flow velocity (CBFV(MCA)) after induced VF depending on the duration of fibrillation and prior values of CBFV(MCA).□ Patients and MethodsSixty induced episodes of VF in 9 patients (mean age±SD 53.5±8 years) were examined during ICD-implantation. Beside the standardized anaesthesiological monitoring, transcranial Doppler sonography was used to record the cerebral blood flow velocity in the middle cerebri artery CBFV(MCA). The duration of the fibrillation-period and the range and duration of the CBFV increase during the post defibrillation-period were correlated. Additionally, we examined whether systematic differences existed between the episodes of each patient (time-trend) by means of 5 following episodes of a patient.□ ResultsDuring all episodes of VF a hyperperfusion was present, that means a time intervall showing increased values of CBFV(MCA), compared to the values present before VF. The duration of hyperperfusion depended significantly on the fibrillation time (r=0,57; p<0,001). The equation of regression is: hyperperfusion time =11,1+1,22×fibrillation time. The amount of hyperperfusion, that means the maximal CBFV after defibrillation, increased significantly with CBFV(MCA) before VF (correlation=0,88; p<0,001). The equation of regression is: hyperperfusion height=6,11+1,22×CBFV(MCA) before VF. The duration of hyperperfusion is not influenced by the maximal CBFV(MCA) after defibrillation (r=0,08; p=0,52). In the examined patients no significant differences in the hyperperfusion time and maximal CBFV(MCA) after defibrillation between the episodes were found.□ ConclusionAfter induced VF you always have to expect a reactive cerebral hyperperfusion. The amount of increase of CBFV after defibrillation depends on the prior values of CBFV before fibrillation and shows a nearly proportional relation to these. The duration of hyperperfusion shows a linear dependency on VF-times. This may show that we had VF-times, in which the cerebral autoregulation and other cerebral physiological reactions compensate the drop of the CBFV(MCA) during VF in the postfibrillation time. In further studies will be examined if there are similar changes in the cerebral metabolism as in CBFV(MCA).

Bewegung und Bedeutung: Naturheilkundliche Physiotherapie und moderne Pharmakotherapie der Osteoporose im semantischen Differential. Quantitative Untersuchung einer Selbsthilfegruppe und zweier Vergleichsgruppen

Movement and Meaning: Complementary and Modern Pharmacological Therapy of Osteoporosis in the Patients’ Space of Meaning. A Quantitative Study Using Semantic Differentials Background: Physiotherapy is a frequently applied concomitant therapy for patients with osteoporosis. Compared to modern pharmacological therapy physiotherapy appears to receive sustained high regard, which should be further examined in view of the attribution pattern of the patients. Objective: Elements of physiotherapy and Kneipp therapy were quantitatively examined in terms of their semantic content in a three-dimensional space of meaning. This was done in comparison with elements of modern pharmacological therapy. The questions regarding possible patterns of the attributions and a possible hierarchy of the therapy forms were analyzed by a survey of a self-help group for osteoporosis patients and two control groups. Material and Methods: According to the methods of semantic differentials, a self-help group for osteoporosis patients and two control groups (high-school female pupils, breast carcinoma patients) were queried about the individual elements of physiotherapy and modern pharmacological therapy in a polar profile of a questionnaire. The results were arranged onto a numerical matrix and by means of factor analysis, a location in a three-dimensional space of meaning was calculated for each element questioned. For purpose of illustration, the results were transferred to a succession of diagrams so that the assessments for the three axes of meaning became more distinct. The results are discussed on the background of a current neurolinguistic theory of meaning: Sensomotoric experience generates meaning in form of ‘primary metaphors’; if reactivated e.g. by physiotherapy, these metaphors can give fundaments for an emergent and salutogenic system of meaning, which helps to reconstruct the patient’s ‘subjective anatomy’ and helps to create new values of living one’s life. Hypotheses: If sensomotoric experience has a central function in generating meaning, the axis of ‘motion’ and therapies stressing on sensomotoric experience (e.g. exercise group) will show a corresponding profile of evaluation throughout the three groups. Results: For the axis ‘motion’ the interventions examined in all three groups show a harmonious profile. The most stable position for all three axes is reflected by ‘exercise group’, followed by ‘whole-body pack’. This stability concerning the axis ‘motion’ as well as ‘exercise group’ is discussed in terms of a neurolinguistic theory of meaning, giving sensomotoric experiences the central function for generating meaning. Conclusions: The results allow conclusions concerning the concrete ‘meaning-oriented’ combination of physiotherapy with modern pharmacotherapy. Moreover, sensomotoric experiences in physiotherapy are possible reasons for an emergent system of meaning reconstructing the patient’s ‘subjective anatomy’ from basic ‘primary metaphors’ of bodily experiences up to a whole salutogenetic system of meaning.

Wirkungen kinetischer Stimuli auf die zerebrale Hämodynamik und den zerebralen Stoffwechsel am Beispiel von aktiven und passiv ausgeführten Bewegungen

Effects of Active and Passive Movement Stimuli on Cerebral Hemodynamics and the Cerebral Metabolism Introduction: In contrast to the well-examined cardiovascular changes during movement stimuli, up to now changes of cerebral hemodynamics and cerebral metabolism have rarely been studied. We investigated the question if active and passive movement stimuli cause changes in the cerebral hemodynamics and the cerebral metabolism. Method: Active and passive repetitive movement stimuli on 14 volunteers (8 females, 6 males, age 35 ± 8 years) were examined. As a parameter of cerebral hemodynamics the mean and the peak blood flow velocity (mCBFVMCA, pCBFVMCA) in the middle cerebral artery (MCA) were recorded by transcranial Doppler sonography. At the same time the noninvasive blood pressure (Penaz method) and the CO2 expiration concentration were investigated on 8 volunteers of the collective. As cerebral metabolic parameters we examined in 4 volunteers additionally the cerebral respiratory chain enzyme cytochrome aa3 (ccytaa3) and the cerebral oxygen saturation (cHbO2) by the transcranial near infrared spectroscopy. With each volunteer 4 measurement series were carried out with a special active and passive exercise program for the right upper as well as the right lower extremity. Each measurement series was formed according to the evoked flow test (R. Aaslid): Exercises were carried out for 20 s, followed by a break of 20 s; this was repeated 10 times for each series. Results: During active exercises of the right lower extremity we found an increase of 13.6% (p < 0.001) of pCBFVMCA and an increase of 3.8% (p = 0.003) of mCBFVMCA. During passive exercises of the lower extremity the increases ran up to 12.3% (p < 0.001) for pCBFVMCA and 3.4% (p = 0.004) for mCBFVMCA. The increases of pCBFVMCA came up to 12.5% (p < 0.001) at active exercises of the right upper extremity, those of mCBFVMCA to 3.5% (p = 0.15). During passive exercises of the upper extremity the pCBFVMCA increased by 12.2% (p < 0.001) and the mCBFVMCA by 4.6% (p = 0.007). Significant increases of ccytaa3 were measured during active exercises of the upper extremity (1.6%; p = 0.04) and of the lower extremity (2.7%, p = 0.007). We also found an increase of ccytaa3 during passive exercises of the upper extremity (1.5%, p = 0.04). Significant changes of cHbO2 were measured with 2.5% (p < 0.05) at active exercises of the lower extremity. Conclusion: These studies show that active as well as passive clinical exercises cause an increase of cerebral blood flow velocity. We attribute the increase of cerebral hemodynamics and cerebral metabolism to cerebral activation and autoregulative mechanisms.