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1. Evidenzbasierte Rehabilitation der Mobilität nach Schlaganfall

Author

S Saal, C Dohle, K M Stephan, H Wittenberg, J Quintern, and R Tholen

Subjects
Gynecology, 030506 rehabilitation, medicine.medical_specialty, business.industry, Treatment outcome, Exercise therapy, General Medicine, 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Neurology, Medicine, Neurology (clinical), 0305 other medical science, business, 030217 neurology & neurosurgery
Abstract

Bei etwa zwei Drittel der Schlaganfallpatienten ist zumindest initial auch die Mobilitat gestort. Zur Rehabilitation werden zahlreiche verschiedene Konzepte postuliert. Welche Rehabilitationsmethoden konnen auf der Basis der Studienlage zur Verbesserung der Gehfahigkeit, der Gehgeschwindigkeit, der Gehstrecke und der Stand- und Gangsicherheit empfohlen werden? Systematische Literaturrecherche nach randomisierten klinischen Studien und Reviews mit klinisch relevanten Zielkriterien der Mobilitat. Formulierung von Empfehlungen, getrennt fur Zielkriterien und den Phasen nach einem Schlaganfall Die Kernmasnahme zur Wiederherstellung und Verbesserung der Gehfahigkeit ist eine hohe Anzahl von Wiederholungen von Gehbewegungen, in Abhangigkeit vom Schweregrad des Patienten gerateunterstutzt. Bei weniger stark betroffenen Patienten wird zur Erhohung der Gehgeschwindigkeit das intensive Gangtraining empfohlen, bei dem die Gerateunterstutzung optional, aber nicht als uberlegen anzusehen ist. Eine Verbesserung der Gehstrecke erfordert aerobes, kardiovaskular wirksames Ausdauertraining, zwingend eingebettet in einen funktionellen Kontext. Die beste Strategie zur Verbesserung der Balance ist nicht das isolierte Balancetraining, sondern das intensive Gangtraining im alltagsrelevanten funktionellen Kontext. Zusatzliche Stimulationsverfahren wirken nur, wenn sie in funktionell relevantes Training eingebunden werden. Die Leitlinie bietet nicht nur klare Handlungsanweisungen, sondern auch pathophysiologische Einsichten zur Funktionserholung des Gehens und Stehens nach einem Schlaganfall.

Published
2016

2. Relation between cerebral activity and force in the motor areas of the human brain

Author

Roger N. Lemon, Richard E. Passingham, K. M. Stephan, David Silbersweig, Andrew P. Holmes, Michael C. Ridding, David J. Brooks, Christian Dettmers, Gereon R. Fink, and R. S. J. Frackowiak

Subjects
Adult, Male, Volunteers, Cingulate cortex, Physiology, Anterior commissure, Motor Activity, Fingers, medicine, Humans, Cingulate sulcus, Cerebral Cortex, Brain Mapping, Supplementary motor area, Electromyography, General Neuroscience, Motor Cortex, Brain, Anatomy, Sulcus, medicine.anatomical_structure, Regional Blood Flow, Posterior cingulate, Linear Models, Cerebellar vermis, Psychology, Neuroscience, Tomography, Emission-Computed, Motor cortex
Abstract

1. Positron emission tomography (PET) studies were performed in six normal right-handed male volunteers (age 30 ± 3) to investigate the relationship between cerebral activation as measured by relative regional cerebral blood flow (rCBF) and force peak exerted during right index finger flexion. The purpose was to determine in which central motor structures activity is directly correlated with force for repeatedly executed movements. 2. Twelve PET rCBF measurements were performed in each volunteer with the use of H215O as a perfusion tracer. Volunteers pressed a Morse-key repetitively with their right index finger for 2 min while lying in a supine position in the PET camera. The device was fitted with strain gauges to measure the force peaks exerted upon it. Scans were collected twice each at five different levels of exerted force peak and in a resting state. Individual and group results were co-registered with anatomic magnetic resonance images (MRI). 3. Group analysis revealed four major regions with a high correlation between rCBF and different degrees of repetitively exerted force peaks. One was located in the arm area of the left lateral surface [primary somatosensory and motor cortex (SI, MI)]. The second area was situated on the left mesial surface of the brain, posterior to the anterior commissure (AC) and encompassing the first gyrus dorsal to the cingulate sulcus. This area is thought to be homologous to the posterior part of the supplementary motor area (SMA) in the monkey. The third area was the dorsal bank of the posterior cingulate sulcus. The fourth area showing a significant correlation between rCBF and force peaks was in the cerebellar vermis. 4. Individual PET data were co-registered with each individual's MRI in order to identify precisely the locations of structures demonstrating a positive correlation between rCBF and force peak. Activated areas on the mesial surface consisted of the same two distinct regions seen in the group data. In three subjects the focus on the lateral surface of the cortex appeared to extend into the caudal promotor area: in two it extended into the rostral part of the superior parietal area. In no subject did blood flow in the anterior cingulate areas and anterior SMA show a correlation with the force exerted. Cerebellar correlations were present in the vermis in all subjects. 5. In addition to the activation in the primary sensorimotor cortex, a comparison of all activated conditions with the resting state revealed a significant activation in the cerebellar vermis, left putamen/claustrum, bilateral insular cortices, right and left ventrolateral premotor areas, bilateral parietal opercular regions (SII), left ventral posterior SMA, and bilateral dorsal posterior SMA. 6. At the lowest force level exerted by the right index finger, rCBF in the right primary sensorimotor cortex showed a decrease relative to rest of 5.9%. At higher force levels, rCBF showed an 8.7% increase. This was associated with electromyographic evidence of contractions of left shoulder muscles. 7. The relationship between relative increase of rCBF and force peaks was logarithmic with an initial steep increase in rCBF reaching a plateau at higher force levels. The initial slope was steepest in MI. This area, together with the posterior cingulate motor area and the ventral part of the posterior SMA constitute an executive motor system responsible for the execution of controlled force pulses by the index finger. This system is a subset of the areas associated with the generation of finger movements and is responsible for all the components that together result in application of the required digital force.

Published
2016

3. Anatomy of Motor Learning. I. Frontal Cortex and Attention to Action

Author

K. M. Stephan, M. Jueptner, R. S. J. Frackowiak, David J. Brooks, Richard E. Passingham, and Chris D. Frith

Subjects
Adult, Male, Cingulate cortex, Frontal cortex, Physiology, Mediodorsal nucleus, Prefrontal Cortex, Fingers, medicine, Humans, Learning, Attention, Prefrontal cortex, General Neuroscience, Anatomy, Human brain, Magnetic Resonance Imaging, medicine.anatomical_structure, Action (philosophy), Cerebrovascular Circulation, Frith, Motor learning, Psychology, Neuroscience, Psychomotor Performance, Tomography, Emission-Computed
Abstract

Jueptner, M., K. M. Stephan, C. D. Frith, D. J. Brooks, R.S.J. Frackowiak, and R. E. Passingham. Anatomy of motor learning. I. Frontal cortex and attention to action. J. Neurophysiol. 77: 1313–1324, 1997. We used positron emission tomography to study new learning and automatic performance in normal volunteers. Subjects learned sequences of eight finger movements by trial and error. In a previous experiment we showed that the prefrontal cortex was activated during new learning but not during automatic performance. The aim of the present experiment was to see what areas could be reactivated if the subjects performed the prelearned sequence but were required to pay attention to what they were doing. Scans were carried out under four conditions. In the first the subjects performed a prelearned sequence of eight key presses; this sequence was learned before scanning and was practiced until it had become overlearned, so that the subjects were able to perform it automatically. In the second condition the subjects learned a new sequence during scanning. In a third condition the subjects performed the prelearned sequence, but they were required to attend to what they were doing; they were instructed to think about the next movement. The fourth condition was a baseline condition. As in the earlier study, the dorsal prefrontal cortex and anterior cingulate area 32 were activated during new learning, but not during automatic performance. The left dorsal prefrontal cortex and the right anterior cingulate cortex were reactivated when subjects paid attention to the performance of the prelearned sequence compared with automatic performance of the same task. It is suggested that the critical feature was that the subjects were required to attend to the preparation of their responses. However, the dorsal prefrontal cortex and the anterior cingulate cortex were activated more when the subjects learned a new sequence than they were when subjects simply paid attention to a prelearned sequence. New learning differs from the attention condition in that the subjects generated moves, monitored the outcomes, and remembered the responses that had been successful. All these are nonroutine operations to which the subjects must attend. Further analysis is needed to specify which are the nonroutine operations that require the involvement of the dorsal prefrontal and anterior cingulate cortex.

Published
1997

4. Fourth meeting of the European Neurological Society 25–29 June 1994 Barcelona, Spain

Author

H. Hattig, C. Delli Pizzi, M. C. Addonizio, Michelle Davis, A. R. Giovagnoli, L. Florensa, M. Roth, J. de Kruijk, Francisco Lacruz, Ph. Dewailly, A. Toygar, C. Avendano, P.P. De Deyn, J. F. Hurtevent, F. Lomeila, T. W. Wong, Gordon T. Plant, M. Bud, H. J. Willison, DH Miller, D. W. Langdon, R. Cioni, J. Servan, A. Kaygisiz, E. Racadot, D. B. Schens, E. Picciola, L. Falip, C. Bouchard, J. Jotova, A. Jorge-Santamaria, P. Misra, A. Dufour, C. P. Panagopoulos, A. Venneri, B. Sredni, B. Angelard, M. Janelidze, M. Carreno, J. Obenberger, J. Pouget, H. W. Moser, R. Kaufmann, J. A. Molina, D. Linden, A. Martin Urda, E. Uvestad, A. Krone, J. P. Cochin, J. Mallecourt, A. Cambon-Thomsen, K. Violleau, P. Osschmann, A. M. Durocher, E. Bussaglia, D. M. Danielle, H. Efendi, C. Van Broeckhoven, K. G. Jordan, W. Rautenberg, C. Iniguez, J. M. Delgado, Graham Watson, M. Lawden, Gareth J. Barker, K. Stiasny, James T. Becker, G. Campanella, E. Peghi, A. Poli, A. Haddad, T. Yamawaki, Giacomo P. Comi, S. Sotgiu, B. Ersmark, A. Pomes, M. Ziegler, P. Ferrante, P. Ruppi, H. KuÇukoglu, R. Bouton, U. K. Rinne, P. Vieregge, M. Dary, P. Giunti, Peter J. Goadsby, S. Jung, E. Secor, A. Steinberg, N. Vila, M. A. Hernandez, M. Cursi, A. Enqelhardt, A. Engelhardt, J. Veitch, F. Di Silverio, F. Arnaud, B. Neundörfer, R. Brucher, Dominique Caparros-Lefebvre, B. Meyer, Marianne Dieterich, M. H. Snidaro, R. Gomez, R. Cerbo, M. Ragno, J. M. Vance, S. Nemni, A. Caliskan, F. Barros, I. Velcheva, D. Ceballos-Baumann, V. Barak, A. Avila, N. Antonova, F. Resche, S. Pappata, L. Varela, S. R. Silveira Santos, A. Cammarota, L. Naccache, Y. Nara, E. Tournier-Lasserves, R. Mobner, T. Chase, A. Ensenyat, J. Ulrich, G. Giegerich, M. Rother, M. Revilla, N. Nitschke, K. Honczarenko, E. Basart Tarrats, J. Blin, B. Jacob, J. Santamaria, S. Knezevic, J. L. Castillo, M. Antem, J. Colomer, O. Busse, Didier Hannequin, S. Carrier, J. B. Ruidavets, C. Rozman, J. Bogoussslavsky, J. Pascual Calvet, E. Monros, J. M. Polo, M. Zucconl, Javier Muruzabal, R. R. Allen, R. Rivolta, K. Haugaard, A. Nespolo, K. Hoang-Xuang, G. Bussone, T. Avramidis, E. Corsini, Christiana Franke, T. Vinogradova, H. Boot, K. Vestergaard, G. H. Jansen, N. Argentino, M. Raltzig, W. Linssen, Mark B. Pepys, P. Roblot, L. Lauritzen, E. Fainardi, D. Morin, T. X. Arbizu Urdiain, J. Wollenhaupt, S. Bostantjopoulou, G. Pavesi, A. D. Forman, Giovanni Fabbrini, D. Jean, J. J. Archelos, M. I. Blanchs, M. Del Gobbo, Anna Carla Turconi, Ch. Derouesné, Elio Scarpini, A. Visbeck, P. Castejon, J. P. Renou, F. Mounier-Vehier, G. Potagas, Ch. Duyckaerts, A. Filla, R. Schneider, G. Ronen, K. Nagata, J. P. Vedel, A. Henneberg, G. van Melle, C. Baratti, H. Knott, M. C. Prevett, A. Bes, B. Metin, Jos V. Reempts, L. Martorell, Mefkure Eraksoy, H. O. Handwerker, D. S. Younger, O. Oktem, D. Frongillo, C. Soriano-Soriano, L. Niehaus, F. Zipp, A. Tartaro, S Newman, R. H. Browne, P. Davous, R. Sanchez, M. Muros, M. E. Kornhuber, A. Lavarone, M. Mohr, M. R. Garcia, S. Russell, H. Kellar-Wood, M. R. Tola, B. Ostermeyer, Ch. Tzekov, K. Sartor, E. B. Ringelstein, P. P. Gazzaniga, Paul Krack, H. Fidaner, H. Rico, T. Dbaiss, F. Alameda, E. Torchiana, L. Rumbach, I. Charques, J. M. Bogaard, C. D. Frith, L. J. Rappelle, R. Brenner, A. Joutel, K. Fuxe, G. HÄcker, M. J. Blaser, J. Valls-SolÇ, G. Ulm, M. Alberdi, A. Bock, F. W. Bertelsmann, U. Wieshmann, J. Visa, J. R. Lupski, D. D'Amico, L. M. P. Ramos, A. A. Vanderbark, R. Horn, M. Warmuth, Dietmar Kühne, Mark S. Palmer, C. Ehrenheim, E. Canga, S. Viola, O. Scarpino, P. Naldi, R. Almeida, A. A. Raymond, J. Gamez, Stephan Arnold, A. DiGiovanni, J. Dalmau, C. C. Chari, H. F. Beer, J. C. Koetsier, J. Iriarte, E. Yunis, J. Casadevall, E. Le Guern, E. Stenager, S. R. Benbadis, J. M. Warter, F. Burklin, I. Theodorou, L. Johannesen, G. A. Graveland, X. Leclerc, I. Vecchio, L. Ozelius, G. Nicoletti, R. K. Gherardi, E. Esperet, M. L. Delodovici, F. Cattin, F. Paiau, Giorgio Sacilotto, C. A. J. Broere, D. Chavdarov, J. P. Willmer, C. H. Hawkes, Th. Naegele, E. Ellie, E. Dartigues, M. J. Guardiola, S. Hesse, Z. Levic, Marco Rovaris, P. Saugeir-Veber, B. A. Yaqub, H. F. Durwen, R. Larumbe, J. Ballabrina, M. Sendtner, J. Röther, M. Horstink, C. Kluglein, M.P. Montesi, H. Apaydin, J. Montoya, E. Waubant, Ch. Verellen-Dunoulin, A. Nicolai, J. Lopez-Delval, R. Lemon, G. Cantinho, E. Granieri, A. Zeviani, Wolfgang H. Oertel, U. Ficola, V. Di Piero, V. Fragola, K. Sabev, M. V. Guitera, I. Turki, F. Bolgert, P. Ingrand, J. M. Gobernado, L. M. E. Grimaldi, S. Baybas, B. Eymard, Y. Rolland, Y. Robitaille, Ta. Pampols, P. J. Koehler, A. Carroacedo, J. Vilchez, S. Di Vittorio, I. R. Rise, T. Nagy, M. Kuffner, E. Palazzini, A. Ott, J. Pruim, T. X. Arbizu, E. Manetti, C. Cervera, S. Felber, G. Gursoy, J. Scholz, G. A. Buscaino, M. S. Chen, A. Pascual, J. Hazan, J. U. Gajda, J. G. Cea, G. Bottini, G. Damalik, F. Le Doze, G. Bonaldi, J. M. Hew, C. Messina, A. M. Kennedy, J. M. Carney, N. M. F. Murray, M. Parent, M. Koepp, V. Dimova, D. De Leo, K. Jellinger, G. Salemi, S. Mientus, M. L. Hansen, F. Mazzucchelli, J. Vieth, M. Mauri, E. Bartels, L. Johannsen, C. Humphreys, J. Emile, D. N. Landon, E. Kansu, R. Sanchez-Pernaute, Rsj Frackowiak, M. Gonzalez Torres, L. Oller, C. Machedo, J. Kother, M. Billiard, H. Durak, T. Schindler, A. Frank, A. Uncini, A. Sbriccoli, C. Farinas, D. W. Paty, N. Fast, A. T. Zangaladze, A. Kerkhofs, J. M. Pino Garcia, I. De la Fuente, B. Marini, L. Gomez, I. Rubio, Alessandra Bardoni, C. Brodie, P. Acin, U. Sliwka, S. A. Hawkins, S. Tardieu, F. Vitullo, J. M. Pereira Monteino, R. Gagliardi, T. Jezewski, A. Cano, T. Lempert, F. Abad Alegria, G. Rotondo, D. Ince, C. Martinez Parra, Y. Huang, H. Luders, Y. Steinvil, F. G. A. Van Der Meche, R. Bianchi, A. Sanchez, T. Sevilla, J. M. Ketelslegers, A. Domzal-Stryga, M. Pandolfo, M. O. Josse, K. W. Neff, I. Blanco, G. W. Bruyn, O. W. Witte, J. L. Thibault, G. Andersen, J. Pariset, A. Marcone, R. J. M. Lane, A. Hofman, M. Verin, T. Matilla, P. Bedoucha, J. Roche, M. Lai, M. Collard, A. Ugarte, F. Gallecho, D. Silbersweig, C. Kennard, J. P. Azulay, T. W. Ho, P. L. I. Dellemijn, R. Girardello, F. Baas, B. Voss, F. Rozenberg, E. M. Brocker, V. Stanev, A. A. J. Soeterboek, A. Marra, A. Rey, E. Ertem, M. Sawradewicz-Rybak, J. De Keyser, P. Cavallari, F. Proust, Y. Chevalier, H. C. Hansen, D. Leys, C. A. Davie, K. Hoang-Xuan, C. Bairati, H. van Crevel, Thomas T. Warner, B. Bompais, A. Dobbeleir, T Campbell, C. Macko, C. J. M. Klijn, M. Dussallant, T. P. Berlit, W. Rozenbaum, M. J. van den Bent, W. A. Rocca, M. Muller, H. Hundemer, U. Zifko, M. Campera, F. Drislane, D. Ranoux, T. M. Kloss, Anil Kumar, I. Ruolt, C. Bargnani, B. Marescau, N. A. Losseff, S. Notermans, B. Kint, E. T. Burke, C. Aykut, J. Matias Guiu, P. Maquet, T. Drogendijk, M. Leone, K. von Ammon, M. Pepeliarska, C. Prados, L. DiGiamberardino, T. Logtenberg, G. Lenoir, I. Castaldo, Damhaut, M. Radionova, G. Sirabian, R. Navon, Giovanni Antonini, K. Al Moutaery, E. Chamas, R. Schönhuber, M. Giannini, B. Debilly, I. Labatut, H. Henon, J. A. Egido, M. Baudrimont, J. N. Lorenzo, J. E. C. Bromberg, R. Antonacci, J. J. Vilchez, T. Moulin, B. Rautenstrauss, Giovanni Meola, J. Noth, S Mammi, P. Laforet, F. Lopez, C. Gehring, S. Bort, G. Rancurel, D. Decamps, S. Kostadinova, Y. Shapira, B. Neundoerfer, D. Chavrot, M. Solimena, J. P. Salier, W. Deberdt, R. Hoff-Jörgensen, A. Messina, S. Meairs, G. Rosoklija, E. Nelis, I. Bertran, C. Ertekin, J. Lohmeyer, Mitermayer Galvao dos Reis, L. Calo, E. Maccagnano, A. P. Hays, J. Verlooy, M. G. Forno, T. Blanco, L. Bail, Gabriella Silvestri, J. Montero, F. Bertrand, R. T. Ghnassia, C. Besses, T. Sereghy, F. Shalit, G. Bogliun, S. Braghi, St. Baykouchev, C. Franke, A. Lasa, L. C. Archard, J. Kriebel, S. Shaunak, M. Nocito, Alexander Tsiskaridze, E. Manfredini, T. Seigal, David G. Gadian, M. Barlas, J. D. Degos, C. Seeber, J. Caemert, J. L. Mas, R. B. Pepinsky, M. G. D'Angelo, N. Baumann, S. Yorifuji, H. P. Endtz, M. A. Cassatella, R. A. C. Hughes, V. Golzi, A. Bittencourt, A. Ferreira, M. Sanson, C. Alper, M. Vermeulen, M. A. A. van Walderveen, E. Alexiou, C. H. Lucas, M. Fiorelli, Y. N. Debbink, R. Gil, S. Congia, T. Banerjee, J. M. Bouchard, A. N. Pinto, A. Ceballos-Baumann, G. Grollier, P. I. M. Schmitz, M. D. Catata, N. Lahat, N. S. Rao, P. Papathanasopoulos, J. Valls-Solé, D. Claus, G. Schroter, A. Castro, C. Videbaek, R. Martinez Dreke, A. D. Platts, M. Hermesl, A. C. PeÇanha-Martins, M. Cardoso Silva, P. Masnou, M. J. A. Tanner, Ch. Confavreux, B. Mishu, H. Rasmussen, L. Valenciano, Carlo Pozzilli, S. W. Li, V. Salzman, Y. Vashtang, Massimo Franceschi, M. Severo, G. Deuschl, S. Setien, G. Mariani, A. Protti, J. Castillo, M. J. B. Taphoorn, M. Frontali, I. Milonas, D. Decoq, J. A. Navarro, S. Castellvi-Pel, C. Ertikin, M. Urtasun, Y. Lajat, B. E. Kendall, E. Verdu, B. Gueguen, E. Boisen, R. Couderc, A Danek, JM Stevens, F. Nicoli, L. Feltri, M. L. Vazquez-Andre, J. A. Morgan-Hughes, L. D'Angelo, F. Y. Liew, L. F. Pascual, J. Patrignani Ochoa, Vittorio Martinelli, J. Cophignon, L. Zhang, S. Martin, J. F. Meder, H. C. Buschmann, L. Bertin, J. van Gijn, A. Barreiro, A. Cools, C. Leon, A. Berod, E. A. Anllo, E. Zanette, L. Petrov, R. Barona, B. Gallicchio, P. J. Cozzone, N. Diederich, G. Cancel, L. Schelosky, P. Orizaola, K. Yulug, S. Ozer, Valeria A. Sansone, B. Guiraud-Chaumeil, K. Voigt, P. Labauge, M. Eoli, J. Zhu, J. Aguirre, M. Ferrarini, B. Zyluk, E. Planas, A. Cadilha, C. Tortorella, H. Bismuth, C. E. Counsell, A. Laun, A. Ferlini, Rio J. Montalban, N. Biary, L. Becker, M. Fardeau, M. Poloni, V. M. S. de Bruin, C. Fornada, J. Barros, E. Ganzmann, E. Touze, D. Wallach, J. Peila, H. Fujimura, M. T. Iba-Zizen, G. Macchi, C. Villoslada, R. Gouider, Ph. Rondepierre, P. Grummich, P. Chiodi, C. Conte, M. Michels, P. Annunziata, G. Semana, C. Sommer, J. Vajsar, D. Zekin, J. Kulisevsky, David G. Munoz, B. Jacotot, M. Magoni, A. Luxen, T. Garcia-Silva, S. Di Cesare, Christophe Tzourio, M. Gomori, I. Picomell, L. Santoro, F. Villa, Giovanni Pennisi, T. Ribalta, J. M. Molto, L. Marzorati, P. Loiseau, F. Gemignani, A. Gironell, J. Wissel, A. Prusinski, F. Cailloux, P. Villanueva-Hemandez, P. Cozzone, T. Del Ser, J. Sans-Sabrafen, M. Zappia, P. W. A. Willems, G. Tchernia, D. Gardeur, R. Bauer, F. Palomo, H. Metz, S. Lamoureux, C. Chastang, I. Reinhard, A. Goldfarb, S. Harder, Jordi Río, C. Ozkara, E. Tekinsoy, P. Vontobell, J. De Recondo, M. Rabasa, L. Lacomblez, F. Boon, Dgt Thomas, V. Palma, Renato Mantegazza, A. Dervis, M. Nueckel, B. YalÇinerner, I. Duran, G. Dalla Volta, A. Zubimendi, J. Pinheiro, A. Marbini, Xavier Montalban, H. Wekerle, X. Pereira Monteino, F. Crespo, F. Koskas, N. Battistini, C. Ruiz, H. Offner, J. de Pommery, P. Kanovsky, J. Y. Barnett, J. Pardo, G. Tomei, R. Rene, H. M. Lokhorst, P. Thajeb, H. Bilgin, D. McGehee, R. Fahsold, L. Morgante, Katie Sidle, C. Delwaide, M. N. Diaye, P. H. Rice, A. Creange, C. Sabev, K. Stephan, K. WeilBenborn, G. Magnani, L. Grymonprez, F. Cardellach, M. Kaps, N. G. Meco, F. Vega, V. Bonifati, A. Desomer, M. Baldy-Moulinier, G. Kvale, F. J. Authier, B. Yegen, T. Ho, J. M. Rozet, E. A. Cabanis, L. Bruce, L. Ambrosoli, M. A. Petrella, M. Hernandez, P. Timmings, H. B. van der Worp, F. Mahieux, A. Urbano-Marquez, D. A. Krendel, A. A. Garcia, R. Divari, R. Michalowicz, M. R. Piedmonte, M. Bondavalli, M. Zanca, P. F. Ippel, Onofre Combarros, B. Tavitian, E. Hirsch, I. Anastasopoulos, A. Roses, A. Köhler, P. Vienna, V. Timmerman, P. Sergi, F. Cornelio, A. Di Pasquale, R. Verleger, S. Castellvirel, J. Proano, B. van Moll, F. Rubio, W. Hacke, I. Lavenu, L. Zetta, M. W. Tas, N. Bittmann, M. Bonamini, O. R. Hommes, V. Dousset, N. Afsar, S. Belal, R. R. Myers, J. Goes, Giuseppe Vita, E. Clementi, V. G. Karepov, M. Jueptner, A Vincent, P. Emmrich, Th. Heb, A. Caballo, J. Gallego, T. Mokrusch, C. Perla, L. Gebuhrer, O. 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Brizioli, J. Calleja, L. Publio, M. Desi, R. Soffietti, P. Cortinovis-Tourniaire, E. F. Gonano, G. Cavaletti, S. Uselli, K. Westerlind, H. Betuel, C. O. Dhiver, H. Guggenheim, M. Hamon, R. Fazio, P. Lehikoinen, A. Esser, B. Sadzot, G. Fink, Angelo Antonini, D. Bendahan, V. Di Carlo, G. Galardi, A. F. Boller, M. Aksenova, Del Fiore, V. de la Sayette, H. Chabriat, A. Nicoletti, A. Dilouya, M. L. Harpin, E. Rouillet, J. Stam, A. Wolters, M. R. Delgado, Eduardo Tolosa, G. Said, A. J. Lees, L. Rinaldi, A. Schulze-Bonhage, MA Ron, C. Lefebvre, E. W. Radü, R. Alvarez, M. L. Bots, P. Reganati, S. Palazzi, A. Poggi, N. J. Scolding, V. Sazdovitch, T. Moreau, E. Maes, M. A. Estelies, P. Petkova, Jose-Felix Marti-Masso, G De La Meilleure, N. Mullatti, M. Rodegher, N. C. Notermans, T. A. T. Warner, S. Aktan, J. P. Louboutin, L. Volpe, C. Scheidt, W. Aust, C. M. Wiles, U. Schneider, S. K. Braekken, W. R. Willems, K. Usuku, Peter M. Rothwell, C. Talamon, M. L. Sacchetti, A. Codina, M. H. Marion, A. 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Bauermann, Nereo Bresolin, J. Vallée, B. C. Jacobs, A. Campos, Werner Poewe, J. A. Villanueva, A. W. Kornhuber, A. Malafosse, E. Diez-Tejedor, G. Jungreia, M. J. A. Puchner, A. Komiyama, O. Saribas, V. Volpini, L. Geremia, S. Bressi, A. Nibbio, Timothy E. Bates, T. z. Tzonev, E. Ideman, G. A. Damlacik, G. Martino, G. Crepaldi, T. Martino, Kjell Någren, E. Idiman, D. Samuel, J. M. Perez Trullen, Y. van der Graaf, J. O. Thorell, M. J. M. Dupuis, E. Sieber, R. D'Alessandro, C. Cazzaniga, J. Faiss, A. Tanguy, A. Schick, I. Hoksergen, A. Cardozo, R. Shakarishvili, G. K. Wennlng, J. L. Marti-Vilalta, J. Weissenbach, I. L. Simone, Amalia C. Bruni, Darius J. Adams, C. Weiller, A. Pietrangeli, F. Croria, C. Vigo-Pelfrey, Patricia Limousin, A. Ducros, G. Conti, O. Lindvall, E. Richter, M. Zuffi, A. Nappo, T. Riise, J. Wijdenes, M. J. Fernandez, J. Rosell, P. Vermersh, S. Servidei, M. S. C. Verdugo, F. Gouttiere, W. Solbach, M. Malbezin, I. S. Watanabe, A. Tumac, W. I. McDonald, D. A. 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C. Patrosso, N. L. Gershfeld, P. A. J. M. Boon, O. Sabouraud, M. Lara, J. Svennevig, G. L. Lenzi, A. Barrio, H. Villaroya, JosÇ M. Manubens, O. Boespflug-Tanguy, M. Carreras, D. A. Costiga, J. P. Breux, S. Lynn, C. Oliveras Ley, A. G. Herbaut, J. Nos, C. Tornali, Y. A. Hekster, J. L. Chopard, J. M. Manubens, P. Chemouilli, A. Jovicic, F. Dworzak, S. Smirne, S. E. Soudain, B. Gallano, D. Lubach, G. Masullo, G. Izquierdo, A. Pascual Leone Pascual, A. Sessa, V. Freitas, O. Crambes, L. Ouss, G. W. Van Dijk, P. Marchettini, P. Confalonieri, M. Donaghy, A. Munnich, M. Corbo, and M. E. L. van der Burg

Subjects
Neurology, business.industry, Media studies, Library science, Medicine, Neurology (clinical), business
Published
1994

5. Averaged and single-trial analysis of cortical activation sequences in movement preparation, initiation, and inhibition

Author

M J, Liu, P B, Fenwick, J, Lumsden, C, Lever, K M, Stephan, and A A, Ioannides

Abstract

We compare estimates of three-dimensional brain activity extracted from averaged and from selected single-trial magnetoencephalographic signals, in order to study activation sequences related to motor preparation, inhibition, and movement, cued on two tones (S1 and S2). We studied all possible hand-ear combinations in a right-handed subject in both initiation and inhibition, and found some marked differences between combinations. Averaging revealed activity in the right motor cortex in all combinations requiring movement inhibition, irrespective of laterality of finger and ear, and in the contralateral motor cortex during movement (but considerably reduced for the task with the practiced ear and finger). These activation patterns are seen in single trials with variability of latency but not position. In the average signal, a long silent period between the warning and imperative stimuli is seen; in single trials, however, recurring sequences of activation linking frontal and posterior areas are seen throughout the analysis period in all combinations. These results show that single-trial analysis is needed to understand all the significant neural correlates of this task.

Published
2010

6. Dynamic scanning of 15O-butanol with positron emission tomography can identify regional cerebral activations

Author

G, Wunderlich, U, Knorr, K M, Stephan, L, Tellmann, N P, Azari, H, Herzog, and R J, Seitz

Abstract

To determine task-specific activations of the human brain in individual subjects, we applied pixel-by-pixel t-map statistics to the regional cerebral perfusion data obtained sequentially by dynamic scanning of [15O]-butanol with positron emission tomography (PET). The listmode data were binned into frames of 2 sec, and multiple corresponding pixel-by-pixel activation-minus-control subtractions were used for t-map calculation. The subtraction frames covering 10-40 sec after tracer arrival in the brain showed the activation-related increase of regional cerebral perfusion. A mismatch of the activation and control data by 2 sec resulted in a mean error of5% of the integrated activity increase. To validate these results, we simulated images with a spatial resolution and signal-to-noise ratio equivalent to that of the [15O]-butanol subtraction images. By means of these simulated images, we determined the minimal data requirements for t-map analysis, the degree of spatial correlations in the image matrix, and the distribution of noise in the t-maps. The simulation results provided a measure to estimate the significance of regional cerebral perfusion changes recorded with [15O]-butanol. The location and spatial extent of regional cerebral activations obtained from dynamic data corresponded closely to those obtained with quantitative measurements of regional cerebral blood flow (rCBF). Our results show that statistical parametric mapping of [15O]-butanol scanning data allows the detection of significant, task-specific brain activations in single activation-control comparisons in individual subjects.

Published
2010

7. Recovery from subcortical stroke--PET activation patterns in patients compared with healthy subjects

Author

K M, Stephan and R S, Frackowiak

Subjects
Cerebrovascular Disorders, Motor Cortex, Humans, Prognosis, Tomography, Emission-Computed
Abstract

The results of experiments with noninvasive monitoring techniques give us ideas about strategies used by the brain during recovery of function. They have their limitations, however, in that they do not allow us to work out underlying mechanism for such recovery. This can only be done by exact physiologic investigations, which can be performed most rigorously in monkeys or other animals. We hope that advances in comparative anatomy and physiology between different primates, including humans, will allow us to combine our knowledge about functional changes in the brain with more fundamental knowledge about their mechanisms. In the future this knowledge may indicate in which way such mechanisms can be modulated either pharmacologically or by physiotherapy to lead to a better outcome for patients.

Published
1997

8. Motor imagery--anatomical representation and electrophysiological characteristics

Author

K. M. Stephan and R. S. J. Frackowiak

Subjects
Adult, Male, medicine.medical_treatment, Movement, Rest, Electromyography, Motor Activity, Biochemistry, Cellular and Molecular Neuroscience, Motor imagery, Oxygen Radioisotopes, medicine, Humans, Learning, Aged, Brain Mapping, medicine.diagnostic_test, Neuropsychology, Brain, General Medicine, Human brain, Middle Aged, Functional imaging, Transcranial magnetic stimulation, medicine.anatomical_structure, Imagination, Motor learning, Psychology, Neuroscience, Mental image, Tomography, Emission-Computed
Abstract

Experience and results of neuropsychological studies have shown that motor imagery can improve motor performance and enhance motor learning. In recent years several electro-physiological and functional imaging studies have investigated the physiological basis for this observation. In the present essay we review two of our recent studies, in which we compared motor imagery with motor preparation and motor execution. In the first we used positron emission tomography to describe their functional anatomy and in the second we employed electromyography, H-reflexes and transcranial magnetic stimulation to delineate their electrophysiological characteristics. Both studies demonstrated that motor imagery shares some characteristics with motor preparation and other, additional ones with motor execution. Thus it can be seen as a special form of motor behaviour, similar but distinct from both motor preparation and execution. This combination of mutual and distinct characteristics may be the key to its successful role in motor learning.

Published
1996

9. Comparison of regional cerebral blood flow with transcranial magnetic stimulation at different forces

Author

Roger N. Lemon, Michael C. Ridding, R. S. J. Frackowiak, Jc Rothwell, K. M. Stephan, and C. Dettmers

Subjects
Adult, Male, medicine.medical_specialty, Physiology, medicine.medical_treatment, Hemodynamics, Fingers, Electromagnetic Fields, Physiology (medical), Internal medicine, Physical Stimulation, Task Performance and Analysis, medicine, Humans, Muscle, Skeletal, medicine.diagnostic_test, business.industry, Motor Cortex, Brain, Magnetic resonance imaging, Body movement, Human brain, Magnetic Resonance Imaging, body regions, Transcranial magnetic stimulation, medicine.anatomical_structure, Cerebral blood flow, Cerebrovascular Circulation, Synapses, Cardiology, Primary motor cortex, business, Neuroscience, Motor cortex, Tomography, Emission-Computed
Abstract

This study's objective was to investigate regional cerebral blood flow (rCBF) within the primary motor cortex (M1) and to compare it with thresholds of transcranial magnetic stimulation (TMS) and electromyographic recordings during exertion of different force levels with the right index finger. Quantitative electromyographic recordings, TMS, and positron emission tomography scans were performed while five and six volunteers, respectively, pressed a Morse key repetitively or with constant force with the right hand at five different force levels: 5, 10, 20, 40, and 60% of the individual's maximum voluntary contraction (MVC). Although at 5% MVC muscle activity was restricted to the first dorsal interosseus muscle, superficial finger flexors, and extensors, there was progressive involvement of proximal muscles during finger flexion with increasing force. rCBF increased logarithmically in the contralateral M1 with increasing force. In ipsilateral M1, rCBF decreased at 5% MVC and then increased logarithmically at higher force levels. TMS thresholds in the contralateral hemisphere declined logarithmically to reach a plateau at high force levels. The threshold in the ipsilateral hemisphere decreased slightly at high force levels. The logarithmic increase of rCBF and decrease of TMS thresholds in the contralateral hemisphere suggest related underlying physiological phenomena; increased cortical synaptic activity and increased excitability. It suggested that the pronounced ipsilateral rCBF alterations reflect transcallosal inhibition and are more prominent during repetitive movements (as used in the positron emission tomography study) than during the generation of a constant force (as exerted during TMS).

Published
1996

10. Funktionelle Anatomie der Vorstellung von Handbewegungen

Author

Chris D. Frith, K. M. Stephan, Gereon R. Fink, Richard E. Passingham, and R. S. J. Frackowiak

Abstract

Vorstellung von Bewegung ist eine Technik, die z.B. regelmassig von vielen Athleten angewandt wird, um ihre Leistungen zu verbessern. Verbesserungen ergeben sich vor allem in den Bereichen, in denen eine genaue sensorische oder visuelle Wahrnehmung und eine fein abgestufte sensomotorische Kontrolle verlangt wird (zur Ubersicht: Denis 1985). Eine Moglichkeit, mehr uber die Mechanismen zu erfahren, die der Vorstellung von Bewegung zugrunde liegen, ist die Messung von Anderungen der regionalen Hirndurchblutung (rCBF) mit Hilfe der Positronen-Emissions-Tomographie (PET). Roland et al. haben 1980 gezeigt, das beim gedanklichen Wiederholen einer Sequenz von Fingerbewegungen die Supplementar motorische Area (SMA) aktiviert wird. Ziel unserer Studie war es, zu untersuchen, ob bei der Vorstellung von Bewegungen auch weitere Hirnareale beteiligt sein konnen. Wir wahlten dazu ein Paradigma, das wahrend der Durchfuhrung von Bewegung SMA, laterale pramotorische und parietale Areale aktivierte (Deiber et al. 1991).

Published
1995

11. Functional anatomy of the mental representation of upper extremity movements in healthy subjects

Author

R. S. J. Frackowiak, Gereon R. Fink, C. D. Frith, Richard E. Passingham, K. M. Stephan, Andres O. Ceballos-Baumann, and David Silbersweig

Subjects
Cingulate cortex, Adult, Male, Physiology, Movement, Posterior parietal cortex, Motor Activity, Premotor cortex, medicine, Humans, Operculum (brain), Aged, Motor Neurons, Brain Mapping, Electronic Data Processing, Leg, Supplementary motor area, General Neuroscience, Parietal lobe, Middle Aged, medicine.anatomical_structure, Frontal lobe, Arm, Psychology, Neuroscience, Brodmann area, Tomography, Emission-Computed
Abstract

1. Differences in the distribution of relative regional cerebral blood flow during motor imagery and execution of a joy-stick movement were investigated in six healthy volunteers with the use of positron emission tomography (PET). Both tasks were compared with a common baseline condition, motor preparation, and with each other. Data were analyzed for individual subjects and for the group, and areas of significant flow differences were related to anatomy by magnetic resonance imaging (MRI). 2. Imagining movements activated a number of frontal and parietal regions: medial and lateral premotor areas, anterior cingulate areas, ventral opercular premotor areas, and parts of superior and inferior parietal areas were all activated bilaterally when compared with preparation to move. 3. Execution of movements compared with imagining movements led to additional activations of the left primary sensorimotor cortex and adjacent areas: dorsal parts of the medial and lateral premotor cortex; adjacent cingulate areas; and rostral parts of the left superior parietal cortex. 4. Functionally distinct rostral and caudal parts of the posterior supplementary motor area (operationally defined as the SMA behind the coronal plane at the level of the anterior commissure) were identified. In the group, the rostral part of posterior SMA was activated by imagining movements, and a more caudoventral part was additionally activated during their execution. A similar dissociation was observed in the cingulate areas. Individual subjects showed that the precise site of these activations varied with the individual anatomy; however, a constant pattern of preferential activation within separate but adjacent gyri of the left hemisphere was preserved. 5. Functionally distinct regions were also observed in the parietal lobe: the caudal part of the superior parietal cortex [medial Brodmann area (BA) 7] was activated by imagining movements compared with preparing to execute them, whereas the more rostral parts of the superior parietal lobe (BA 5), mainly on the left, were additionally activated by execution of the movements. 6. Within the operculum, three functionally distinct areas were observed: rostrally, prefrontal areas (BA 44 and 45) were more active during imagined than executed movements; a ventral premotor area (BA 6) was activated during both imagined and executed movements; and more caudally in the parietal lobe, an area was found that was mainly activated by execution presumably SII. 7. These data suggest that imagined movements can be viewed as a special form of "motor behavior' that, when compared with preparing to move, activate areas associated heretofore with selection of actions and multisensory integration.(ABSTRACT TRUNCATED AT 400 WORDS)

Published
1995

12. Vergleich von MEG und PET Daten anhand eines CNV Paradigmas

Author

G. R. Fink, D. Lawson, K. M. Stephan, K.C. Squires, Jürgen Vieth, John Lumsden, P.B.C. Fenwick, Richard S. J. Frackowiak, P. Grummich, A.A. Ioannides, and Helmut Kober

Abstract

Die Positronen-Emissions-Tomographie (PET) und die Magnetoenzephalographie (MEG) geben auf unterschiedliche Weise Informationen uber die Funktion des Gehirns: PET kann Veranderungen der Hirndurchblutung mesen, wahrend MEG Anderungen magnetischer Felder erfast.

Published
1995

13. Neuronale Aktivierungen in kortikalen und subkortikalen Hirnregionen bei der Durchführung von Beinbewegungen

Author

Jdg Watson, R. S. J. Frackowiak, T. Jones, K. M. Stephan, Gereon R. Fink, B. Wuyam, J. A. Innes, Douglas R. Corfield, I. Kobayashi, K. Murphy, L. Adams, and A. Guz

Abstract

Bereits im Jahr 1936 hat der Neurochirurg Foerster seine auf elektrokortikalen Stimulationen beruhende Hirnkarte publiziert, die die kortikale Reprasentation des menschlichen Korpers zeigt (Foerster 1936). Besonders ausfuhrlich stellte er die somatotope Differenzierung innerhalb des primar motorischen und sensorischen Kortex dar, wie sie in weiteren Untersuchungen auch von Penfield und Mitarbeitern bestatigt wurde (Penfield und Boldrey 1937). Trotz einer ausgepragten inter- und intraindividuellen Variabilitat der stimulierbaren Bereiche hat dies zu dem didaktisch vereinfachenden Konzept der “homunculus”-artigen Reprasentation des menschlichen Korpers im Kortex gefuhrt. Allerdings ist sowohl den elektrokortikalen wie auch den mittlerweile durchfuhrbaren transkraniell magnetischen Stimulationen beim Menschen (zumindest im Regelfall) nur die kortikale Konvexitatsoberflache zugangig. Auch Penfield und Forster haben die Reprasentation im Interhemispherenspalt “extrapoliert”, wie beim Studium ihrer Originaldaten zu erkennen ist. Die meisten Informationen, die wir heute uber andere an der Durchfuhrung von Bewegungen beteiligte kortikale und subkortikale Areale (wie z.B. die supplementar motorische Area, den Gyrus cinguli, die Brodman Areae 5 und 6 sowie das Putamen) haben, basieren deswegen hauptsachlich auf tierexperimentellen Befunden.

Published
1995

14. Cerebral activation during the exertion of sustained static force in man

Author

Gereon R. Fink, Richard S. J. Frackowiak, Roger N. Lemon, K. M. Stephan, and Christian Dettmers

Subjects
Adult, Male, medicine.medical_specialty, Physical Exertion, Hemodynamics, Electromyography, Functional Laterality, Fingers, Oxygen Radioisotopes, Internal medicine, Basal ganglia, medicine, Humans, Exertion, Muscle, Skeletal, Brain Mapping, medicine.diagnostic_test, General Neuroscience, Brain, Motor control, medicine.anatomical_structure, Cerebral blood flow, Cerebrovascular Circulation, Cardiology, Force dynamics, Psychology, Neuroscience, Tomography, Emission-Computed, Motor cortex
Abstract

The aim of our study was to determine alterations of cerebral activity during prolonged static force exertion. Regional cerebral blood flow (rCBF) was measured using H2(15)O positron emission tomography (PET) while six male normal subjects pressed a morse-key with their right index finger with a constant force of 20% of their maximal voluntary contraction (MVC) for different periods of time (1.5-4.5 min). Exertion of static force led to activation which was at least as extensive as that during exertion of repetitive dynamic force pulses. Despite a considerable sense of fatigue and increased effort at the end of a 4.5 min key press, no compensatory changes of activity were detected in motor or sensory related structures. The right dorsolateral prefrontal cortex demonstrated a significant correlation between rCBF and duration of key-press, possibly reflecting processes over-riding fatigue. Prominent basal ganglia activation was demonstrated in this static force task, but not in a previous force task involving repetitive dynamic force pulses. This suggests that sustained exertion of a static force is an active process modulated, at least in part, by the basal ganglia.

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