Recovery of gait and other motor functions after stroke: novel physical and pharmacological treatment strategies.

The gait-lab at Klinik Berlin developed and evaluated novel physical and pharmacological strategies promoting the repetitive practise of hemiparetic gait in line with the slogan: who wants to relearn walking, has to walk. Areas of research are treadmill training with partial body weight support, enabling wheelchair-bound subjects to repetitively practice gait, the electromechanical gait trainer GT I reducing the effort on the therapists as compared to the manually assisted locomotor therapy, and the future HapticWalker which will allow the additional practise of stair climbing up and down and of perturbations. Further means to promote gait practice after stroke was the application of botulinum toxin A for the treatment of lower limb spasticity and the early use of walking aids. New areas of research are also the study of D-Amphetamine, which failed to promote motor recovery in acute stroke patients as compared to placebo, and the development of a computerized arm trainer, Bi-Manu-T rack, for the bilateral treatment of patients with a severe upper limb paresis.

[1]  J. Misiaszek,et al.  The relationship between the kinematics of passive movement, the stretch of extensor muscles of the leg and the change induced in the gain of the soleus H reflex in humans , 1995, Brain Research.

[2]  B. Sjölund,et al.  Walking training of patients with hemiparesis at an early stage after stroke: a comparison of walking training on a treadmill with body weight support and walking training on the ground , 2001, Clinical rehabilitation.

[3]  S. Hesse,et al.  Influence of walking speed on lower limb muscle activity and energy consumption during treadmill walking of hemiparetic patients. , 2001, Archives of physical medicine and rehabilitation.

[4]  K. Mauritz,et al.  Gait Outcome in Ambulatory Hemiparetic Patients After a 4‐Week Comprehensive Rehabilitation Program and Prognostic Factors , 1994, Stroke.

[5]  S. Hesse,et al.  Botulinum toxin type A and short-term electrical stimulation in the treatment of upper limb flexor spasticity after stroke: a randomized, double-blind, placebo-controlled trial , 1998, Clinical rehabilitation.

[6]  S. Hesse,et al.  Robot-assisted arm trainer for the passive and active practice of bilateral forearm and wrist movements in hemiparetic subjects. , 2003, Archives of physical medicine and rehabilitation.

[7]  M. Viitanen,et al.  A Double-Blind Placebo-Controlled Study of the Effects of Amphetamine and Physiotherapy after Stroke , 2001, Cerebrovascular Diseases.

[8]  K. Mauritz,et al.  Short-term electrical stimulation enhances the effectiveness of Botulinum toxin in the treatment of lower limb spasticity in hemiparetic patients , 1995, Neuroscience Letters.

[9]  J. Mehrholz,et al.  Speed-Dependent Treadmill Training in Ambulatory Hemiparetic Stroke Patients: A Randomized Controlled Trial , 2002, Stroke.

[10]  E. Protas,et al.  Gait outcomes after acute stroke rehabilitation with supported treadmill ambulation training: a randomized controlled pilot study. , 2002, Archives of physical medicine and rehabilitation.

[11]  T. K. Das,et al.  Botulinum toxin in treating spasticity , 1989, The British journal of clinical practice.

[12]  B. Whaler,et al.  Influence of nerve‐ending activity and of drugs on the rate of paralysis of rat diaphragm preparation by Cl. botulinum type A toxin , 1962, The Journal of physiology.

[13]  N. Hogan,et al.  Overview of clinical trials with MIT-MANUS: a robot-aided neuro-rehabilitation facility. , 1999, Technology and health care : official journal of the European Society for Engineering and Medicine.

[14]  C. Burgar,et al.  Robot-assisted movement training compared with conventional therapy techniques for the rehabilitation of upper-limb motor function after stroke. , 2002, Archives of physical medicine and rehabilitation.

[15]  A. Pollock,et al.  Treadmill training and body weight support for walking after stroke. , 2005, The Cochrane database of systematic reviews.

[16]  Gerald V. Smith,et al.  Treadmill training improves fitness reserve in chronic stroke patients. , 2001, Archives of physical medicine and rehabilitation.

[17]  P. Davies Steps to Follow: A Guide to the Treatment of Adult Hemiplegia: Based on the Concept of K. and B. Bobath , 1991 .

[18]  M. Maležič,et al.  Treadmill training with partial body weight support compared with physiotherapy in nonambulatory hemiparetic patients. , 1995, Stroke.

[19]  I. Miyai,et al.  Treadmill training with body weight support: its effect on Parkinson's disease. , 2000, Archives of physical medicine and rehabilitation.

[20]  O. Hardiman,et al.  A Double-Blind Randomised Placebo-Controlled Evaluation of Three Doses of Botulinum Toxin Type A (Dysport®) in the Treatment of Spastic Equinovarus Deformity after Stroke , 2003, Cerebrovascular Diseases.

[21]  F. Tang,et al.  CLINICAL TRIAL OF A LOW-TEMPERATURE PLASTIC ANTERIOR ANKLE FOOT ORTHOSIS , 1992, American journal of physical medicine & rehabilitation.

[22]  D. Walker-Batson,et al.  Amphetamine paired with physical therapy accelerates motor recovery after stroke. Further evidence. , 1995, Stroke.

[23]  S. Hesse,et al.  Treadmill Training With Partial Body Weight Support and an Electromechanical Gait Trainer for Restoration of Gait in Subacute Stroke Patients: A Randomized Crossover Study , 2002, Stroke.

[24]  B. Bioulac,et al.  A randomised, double blind, placebo controlled trial of botulinum toxin in the treatment of spastic foot in hemiparetic patients. , 1996, Journal of neurology, neurosurgery, and psychiatry.

[25]  L. Tenteromano,et al.  Abstract 21: Treadmill with partial body-weight support versus conventional gait training after stroke.1 , 2003 .

[26]  S. Miyazaki,et al.  Effect of ankle-foot orthosis on active ankle moment in patients with hemiparesis , 1997, Medical and Biological Engineering and Computing.

[27]  S Hesse,et al.  Non-velocity-related effects of a rigid double-stopped ankle-foot orthosis on gait and lower limb muscle activity of hemiparetic subjects with an equinovarus deformity. , 1999, Stroke.

[28]  S. Hesse,et al.  Lower limb muscle activity in ambulatory children with cerebral palsy before and after the treatment with Botulinum toxin A. , 2000, Restorative neurology and neuroscience.

[29]  N. Hogan,et al.  A novel approach to stroke rehabilitation , 2000, Neurology.

[30]  K. Mauritz,et al.  Ankle muscle activity before and after botulinum toxin therapy for lower limb extensor spasticity in chronic hemiparetic patients. , 1996, Stroke.

[31]  A. Pollock,et al.  Treadmill Training and Body Weight Support for Walking After Stroke , 2003, The Cochrane database of systematic reviews.

[32]  Cordula Werner,et al.  Treadmill training with partial body-weight support after total hip arthroplasty: a randomized controlled trial. , 2003, Archives of physical medicine and rehabilitation.

[33]  R. J. Gregor,et al.  Effects of training on the recovery of full-weight-bearing stepping in the adult spinal cat , 1986, Experimental Neurology.

[34]  S. Hesse,et al.  Development of an Advanced Mechanised Gait Trainer, Controlling Movement of the Centre of Mass, for Restoring Gait in Non-ambulant Subjects - Weiterentwicklung eines mechanisierten Gangtrainers mit Steuerung des Massenschwerpunktes zur Gangrehabilitation rollstuhlpflichtiger Patienten , 1999, Biomedizinische Technik. Biomedical engineering.

[35]  S. Hesse,et al.  A mechanized gait trainer for restoration of gait. , 2000, Journal of rehabilitation research and development.

[36]  S. Hesse,et al.  No benefit from D-amphetamine when added to physiotherapy after stroke: a randomized, placebo-controlled study , 2003, Clinical rehabilitation.

[37]  M. Hallett,et al.  Improving hand function in chronic stroke. , 2002, Archives of neurology.

[38]  Mary Vining Radomski,et al.  Steps to Follow. A Guide to the Treatment of Adult Hemiplegia Based on the Concept of K. and B. Bobath , 1986 .

[39]  M. Maležič,et al.  Restoration of gait in nonambulatory hemiparetic patients by treadmill training with partial body-weight support. , 1994, Archives of physical medicine and rehabilitation.

[40]  V. Dietz,et al.  Treadmill training of paraplegic patients using a robotic orthosis. , 2000, Journal of rehabilitation research and development.

[41]  K H Mauritz,et al.  Gait function in spastic hemiparetic patients walking barefoot, with firm shoes, and with ankle‐foot orthosis , 1996, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[42]  P. Davies,et al.  Steps to Follow , 2000, Springer Berlin Heidelberg.

[43]  D. M. Feeney,et al.  Amphetamine, haloperidol, and experience interact to affect rate of recovery after motor cortex injury. , 1982, Science.

[44]  H. Barbeau,et al.  Description and application of a system for locomotor rehabilitation , 1987, Medical and Biological Engineering and Computing.

[45]  S. Hesse,et al.  Treadmill training with partial body weight support after stroke. , 2003, Physical medicine and rehabilitation clinics of North America.

[46]  M. Reding,et al.  Comparison of Partial Body Weight-Supported Treadmill Gait Training Versus Aggressive Bracing Assisted Walking Post Stroke , 2000, Neurorehabilitation and neural repair.

[47]  Stefan Hesse,et al.  Treadmill Training with Partial Body Weight Support: Influence of Body Weight Release on the Gait of Hemiparetic Patients , 1997 .

[48]  K H Mauritz,et al.  Restoration of gait by combined treadmill training and multichannel electrical stimulation in non-ambulatory hemiparetic patients. , 1995, Scandinavian journal of rehabilitation medicine.

[49]  S. Tyson The support taken through walking aids during hemiplegic gait , 1998, Clinical rehabilitation.

[50]  D. Tk,et al.  Botulinum toxin in treating spasticity. , 1989 .

[51]  H Kern,et al.  Treadmill training with partial body weight support in nonambulatory patients with cerebral palsy. , 2000, Archives of physical medicine and rehabilitation.

[52]  J. Lehmann,et al.  Gait abnormalities in hemiplegia: their correction by ankle-foot orthoses. , 1987, Archives of physical medicine and rehabilitation.

[53]  S. Hesse,et al.  An Electromechanical Gait Trainer for Restoration of Gait in Hemiparetic Stroke Patients: Preliminary Results , 2001, Neurorehabilitation and neural repair.

[54]  A. Wernig,et al.  Laufband locomotion with body weight support improved walking in persons with severe spinal cord injuries , 1992, Paraplegia.

[55]  R. Shepherd,et al.  The changing face of neurological rehabilitation , 2006 .