TRFII-5

Principle Investigator(s):

Klaus Jahn, MD

Friedemann Müller, MD, Dipl.-Psych.

Eberhard Koenig, MD

 

Objectives:

The goal of this project is to improve diagnostics and treatment of impaired upright body orientation in neurorehabilitation.

 

Project description(s):

 

I.)    Development: testing human verticality perception

 

 Abbildung-1

 

Subproject 1 focuses on the development of a diagnostic tool for quantification of impaired verticality perception during standing. We hypothesize that the subjective visual vertical (SVV) and the subjective postural vertical (SPV) reflect different aspects of verticality control: The SVV tests preferentially the vestibular and visual functions, whereas the SPV is strongly influenced by somatosensory input.

The subjective postural vertical (SPV) is a psychophysical measure to investigate the internal estimate of verticality. SPV assessment has been performed primarily in sitting, but the inner representation of verticality might be different between sitting and standing mainly because of differences in the somatosensory input. We recently started to set up a system to measure the SPV in standing. We will further determine factors contributing to verticality perception in standing by assessing the SPV in patients with sensory loss in different domains and by experimentally manipulating sensory afferents.

 

II.)   Diagnostics: verticality perception in postural disorders

 

Subproject 2 focuses on the integration of verticality assessment in the clinical routine. We hypothesize that SPV provides complementary information to routine clinical measures.

In this subproject we plan to include SPV assessment in standing in the clinical routine in the DSGZ and the Schön Klinik Bad Aibling. We expect that the SPV provides complementary information to routine clinical measures, in particular in severely affected patients. The SPV might not only yield prognostic information but also quantitative measures and continuous variables for follow-up during the rehabilitation process. We will combine and correlate SPV measurements with established clinical measures in order to establish a set of tools for the assessment of postural disorders in the DSGZ outpatient unit.

 

III.) Treatment: feasibility of balance training in the Spacecurl

 

 Abbildung-2

 

Subproject 3 focuses on the development of new treatment methods to improve impaired verticality perception. We hypothesize that patients with imbalance will benefit from training of verticality perception also to improve the ability to stand and walk. 

In this project we conduct a feasibility study on balance training with the Spacecurl in stroke patients. Most approaches to improve balance and upright body orientation are not feasible for severely affected patients after stroke, not being able to stand unassisted. The Spacecurl allows balance training in an upright body position while being sufficiently secured to prevent falling. The aim of the present pilot study is to guide the planning of a larger randomized clinical trial in the future.

 

Methods:

  • SPV, SVV, posturography, gait analysis, galvanic stimulation, visual stimulation, vibro-tactile stimulation (MCM-T)
  • MR imaging with lesion mapping (MCM-I)
  • Computational modeling (MCM-M)

 

Relevant publications:

Bergmann J, Kreuzpointner MA, Krewer C, Bardins S, Schepermann A, Koenig E, Müller F, Jahn K. (2015) The subjective postural vertical in standing: Reliability and normative data for healthy subjects. Atten Percept Psychophys 77: 953-960.

Bergmann J, Krewer C, Rieß K, Müller F, Koenig E, Jahn K (2014). Inconsistent classification of pusher behaviour in stroke patients: A direct comparison of the Scale for Contraversive Pushing and the Burke Lateropulsion Scale. Clinical Rehabilitation, 28: 696-703.

Husemann, B., Müller, F., Krewer, C., Heller, S., Koenig, E. (2007) Effects of locomotion training with assistance of a robot-driven gait orthosis in hemiparetic patients after stroke: a randomized controlled pilot study. Stroke 38, 349-354.

Krewer C, Riess K, Bergmann J, Müller F, Jahn K, Koenig E. (2013) Immediate effectiveness of single-session therapeutic interventions in pusher behaviour. Gait & Posture 37: 246-250.

Krewer C, Luther M, Müller F. Koenig E (2013). Time course of pusher behaviour in a rehabilitation setting and the influence on rehabilitation outcome – A prospective cohort study. Topics in Stroke Rehabilitation, 20: 331-339.

Volkening K, Bergmann J, Keller I, Wuehr M, Müller F, Jahn K. (2014) Verticality perception during and after galvanic vestibular stimulation. Neurosci Lett 581: 75-79.

 

Team:

jahn mueller koenig
Klaus Jahn     Friedemann Müller Eberhard Koenig
bergemann selge stani
Jeannine Bergmann Charlotte Selge  Stanislav Bardins