Herta Flor

A spelling device for the paralysed.

When Jean-Dominique Bauby suffered from a cortico-subcortical stroke that led to complete paralysis with totally intact sensory and cognitive functions, he described his experience in The Diving-Bell and the Butterfly as “something like a giant invisible diving-bell holds my whole body prisoner”. This horrifying condition also occurs as a consequence of a progressive neurological disease, amyotrophic lateral sclerosis, which involves progressive degeneration of all the motor neurons of the somatic motor system. These ‘locked-in’ patients ultimately become unable to express themselves and to communicate even their most basic wishes or desires, as they can no longer control their muscles to activate communication devices. We have developed a new means of communication for the completely paralysed that uses slow cortical potentials (SCPs) of the electro-encephalogram to drive an electronic spelling device.

Efficacy of multidisciplinary pain treatment centers: a meta-analytic review.

&NA; Sixty‐five studies that evaluated the efficacy of multidisciplinary treatments for chronic back pain were included in a meta‐analysis. Within‐ and between‐group effect sizes revealed that multidisciplinary treatments for chronic pain are superior to no treatment, waiting list, as well as single‐discipline treatments such as medical treatment or physical therapy. Moreover, the effects appeared to be stable over time. The beneficial effects of multidisciplinary treatment were not limited to improvements in pain, mood and interference but also extended to behavioral variables such as return to work or use of the health care system. These results tend to support the efficacy of multidisciplinary pain treatment; however, these results must be interpreted cautiously as the quality of the study designs and study descriptions is marginal. Suggestions for improvement in research designs as well as appropriate reports of research completed are provided.

Activation of Cortical and Cerebellar Motor Areas during Executed and Imagined Hand Movements: An fMRI Study

Brain activation during executed (EM) and imagined movements (IM) of the right and left hand was studied in 10 healthy right-handed subjects using functional magnetic resonance imagining (fMRI). Low electromyographic (EMG) activity of the musculi flexor digitorum superficialis and high vividness of the imagined movements were trained prior to image acquisition. Regional cerebral activation was measured by fMRI during EM and IM and compared to resting conditions. Anatomically selected regions of interest (ROIs) were marked interactively over the entire brain. In each ROI activated pixels above a t value of 2.45 (p < 0.01) were counted and analyzed. In all subjects the supplementary motor area (SMA), the premotor cortex (PMC), and the primary motor cortex (M1) showed significant activation during both EM and IM; the somatosensory cortex (S1) was significantly activated only during EM. Ipsilateral cerebellar activation was decreased during IM compared to EM. In the cerebellum, IM and EM differed in their foci of maximal activation: Highest ipsilateral activation of the cerebellum was observed in the anterior lobe (Larsell lobule H IV) during EM, whereas a lower maximum was found about 2-cm dorsolateral (Larsell lobule H VII) during IM. The prefrontal and parietal regions revealed no significant changes during both conditions. The results of cortical activity support the hypothesis that motor imagery and motor performance possess similar neural substrates. The differential activation in the cerebellum during EM and IM is in accordance with the assumption that the posterior cerebellum is involved in the inhibition of movement execution during imagination.

The thought translation device (TTD) for completely paralyzed patients

The thought translation device trains locked-in patients to self-regulate slow cortical potentials (SCPs) of their electroencephalogram (EEG). After operant learning of SCP self-control, patients select letters, words or pictograms in a computerized language support program. Results of five respirated, locked-in-patients are described, demonstrating the usefulness of the thought translation device as an alternative communication channel in motivated totally paralyzed patients with amyotrophic lateral sclerosis.

Constraint-induced movement therapy for motor recovery in chronic stroke patients.

OBJECTIVEnAssessment of the effectiveness of constraint-induced (CI) movement therapy and quantitative evaluation of the effects of CI therapy.nnnDESIGNnIntervention study; case series; pretreatment to posttreatment measures and follow-up 3 months after intervention.nnnSETTINGnAn outpatient department.nnnPATIENTSnFive chronic stroke patients with moderate motor deficit; convenience sample.nnnINTERVENTIONSnCI therapy consisting of restraint of the unaffected upper extremity in a sling for 14 days combined with 6 hours of training per weekday of the affected upper extremity.nnnMAIN OUTCOME MEASURESnActual Amount of Use Test (AAUT), Motor Activity Log (MAL), Wolf Motor Function Test (WMFT), and Arm Motor Ability Test (AMAT) RESULTS: There was a substantial improvement in the performance times of the laboratory tests (AMAT, WMFT, p < or = .039) and in the quality of movement (AMAT, WMFT, p < or = .049; MAL, p = .049), particularly in the use of the extremity in real world environments (AAUT, p = .020), supported by results of quantitative evaluation. The effect sizes were large and comparable to those found in previous studies of CI therapy.nnnCONCLUSIONSnCI therapy is an efficacious treatment for chronic stroke patients, especially in terms of real world outcome.

Does use of a myoelectric prosthesis prevent cortical reorganization and phantom limb pain

Injury, stimulation or training can induce changes in the homuncular organization of primary somatosensory (S1) and motor cortex (M1). Phantom limb pain was identified as a perceptual correlate of this cortical reorganization. Using functional magnetic resonance imaging (fMRI), we found that enhanced use of a myoelectric prosthesis in upper extremity amputees was associated with reduced phantom limb pain and reduced cortical reorganization. Extensive use of a myoelectric prosthesis might have beneficial effects on phantom limb pain.

Chronic back pain and rheumatoid arthritis: predicting pain and disability from cognitive variables.

Cognitive-behavioral models of chronic pain emphasize the importance of situation specific as well as more general cognitive variables as mediators of emotional and behavioral reactions to nociceptive sensations and physical impairment. The relationship of situation-specific pain-related self-statements, convictions of personal control, pain severity, and disability levels was assessed in samples of chronic back pain and rheumatoid arthritis patients. Both the more general and the situation-specific sets of cognitive variables were more highly related to pain and disability than disease-related variables. This association was found in the back pain patients who displayed only marginal levels of organic findings as well as the rheumatoid arthritis sample who had a documented basis for their pain. The combination of both situation-specific and general cognitive variables explained between 32 and 60% of the variance in pain and disability, respectively. The addition of disease-related variables improved the predictions only marginally. These results lend support to the importance of cognitive factors in chronic pain syndromes.

Assessment of pain-related cognitions in chronic pain patients

The construction of the Pain-Related Self Statements Scale (PRSS) and the Pain-Related Control Scale (PRCS) is described. The PRSS assesses situation-specific aspects of patients cognitive coping with pain, while the PRCS measures general attitudes towards pain. The reliability and validity of these scales were determined in a sample of 120 chronic pain patients suffering from various rheumatic disorders, 213 patients who suffered from chronic back pain, 44 patients with temporomandibular pain and dysfunction and 38 healthy controls. The analysis of the PRSS yielded two scales termed Catastrophizing and Coping; the PRSC consists of the subscales Helplessness and Resourcefulness. All four subscales were demonstrated to be valid and sensitive to change, and they are closely related to pain intensity and interference from pain experiences.

fMRI Evaluation of Somatotopic Representation in Human Primary Motor Cortex

We used fMRI to map foot, elbow, fist, thumb, index finger, and lip movements in 30 healthy subjects. For each movement type confidence intervals of representational sites in the primary motor cortex (M1) were evaluated. In order to improve the precision of their anatomical localization and to optimize the mapping of cortical activation sites, we used both the assessment of locations in the conventional 3D system and a 2D projection method. In addition to the computation of activation maxima of activation clusters within the precentral gyrus, centers of gravity were determined. Both methods showed a high overlap of their representational confidence intervals. The 2D-projection method revealed statistically significant distinct intralimb locations, e.g., elbow versus index finger movements and index finger versus thumb movements. Increased degree of complexity of finger movements resulted in a spread of the somatotopic location toward the arm representation. The 2D-projection method-based fMRI evaluation of limb movements showed high precision and was able to reveal differences in intralimb movement comparisons. fMRI activation revealed a clear somatotopic order of movement representation in M1 and also reflected different degrees of complexity of movement.

The arm motor ability test: Reliability, validity, and sensitivity to change of an instrument for assessing disabilities in activities of daily living

OBJECTIVEnTo continue and expand determination of the reliability, validity, and sensitivity to change of the Arm Motor Ability Test (AMAT), an instrument for assessing deficits in activities of daily living (ADL).nnnDESIGNnThe AMAT was administered twice to patients, with an interest interval of either 1 or 2 weeks, by one of two examiners assigned to patients in counterbalanced order. Patients interest intervals and scores on the arm portion of the Motricity Index was unknown to the raters.nnnSETTINGnA referral inpatient neurological rehabilitation center.nnnPATIENTSnThirty-three subacute stroke inpatients with moderate to mild upper extremity motor deficit: median Motricity-Index-Arm score = 89, median chronicity = 43d, median age = 66yr; 12 were women.nnnMAIN OUTCOME MEASURE AND RESULTSnThe AMAT was developed in 1987, and interrater reliabilities at that time were found to range from .95 to .99. The present values for interrater reliability (2 scales) from videotaped test performance were: kappas = .68 to .77. Spearman correlations = .97 to .99. For performance time, interscorer reliability from videotaped test performance was .99. Homogeneities for the three AMAT measures for the total sample (Cronbachs alpha and split-half reliability) were .93 to .99. The test-retest reliabilities for the total sample were .93 to .99. The correlations to the Motricity-Index-Arm score were .45 to .61. The AMAT detected the difference in change occurring as a result of the passage of 1 versus 2 weeks in these subacute inpatients, presumably as a result of intensive therapy and/or spontaneous recovery, confirming the results of an earlier intervention study.nnnCONCLUSIONnThe AMAT is an instrument with high interrater reliability, internal consistency, and sensitivity to change, as well as having satisfactory concurrent validity.