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Publications (13)29.08 Total impact

  • Susanna Freivogel · Jan Mehrholz · Wolfgang Fries · Martin Lotze · Klaus Starrost ·

    03/2014; 06(01):1-1. DOI:10.1055/s-0034-1372448
  • Claudia Miklitsch · Carmen Krewer · Susanna Freivogel · Diethard Steube ·
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    ABSTRACT: Objective:To investigate the effects of a predefined mini-trampoline therapy programme for increasing postural control, mobility and the ability to perform activities of daily living after stroke.Design:Randomized non-blinded controlled pilot study.Setting:Neurological rehabilitation hospital.Subjects:First-time stroke; age 18-80 years; independent standing ability for a minimum of 2 minutes.Intervention:Patients were randomized into two groups: the mini-trampoline group (n = 20) received 10 sessions of balance training using the mini-trampoline over three weeks. The patients of the control group (n =20) participated 10 times in a group balance training also over three weeks.Main measures:Postural control (Berg Balance Scale, BBS), mobility and gait endurance (timed 'up and go' test, TUG; 6-minute walk test, 6MWT) and the ability to perform activities of daily living (Barthel Index, BI). Measurements were undertaken prior to and after the intervention period.Results:Both groups were comparable before the study. The mini-trampoline group improved significantly more in the BBS (P = 0.003) compared to the control group. Mean or median differences of both groups showed improvements in the TUG 10.12 seconds/7.23 seconds, the 6MWT 135 m/75 m and the BI 20 points/13 points for the mini-trampoline and control group, respectively. These outcome measurements did not differ significantly between the two groups.Conclusion:A predefined mini-trampoline training programme resulted in significantly increased postural control in stroke patients compared to balance training in a group. Although not statistically significant, the mini-trampoline training group showed increased improvement in mobility and activities of daily living. These differences could have been statistically significant if we had investigated more patients (i.e. a total sample of 84 patients for the TUG, 98 patients for the 6MWT, and 186 patients for the BI).
    Clinical Rehabilitation 07/2013; 27(10). DOI:10.1177/0269215513485591 · 2.24 Impact Factor
  • Susanna Freivogel · Jan Mehrholz · Wolfgang Fries ·

    02/2013; 5(01):1-1. DOI:10.1055/s-0033-1337339
  • Wolfgang Fries · Susanna Freivogel · Peter Frommelt · Hubert Lösslein ·
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    ABSTRACT: Die Therapie willkürmotorischer Störungen hat sich in den letzten Jahren zunehmend von einem von »Schulen« geprägten Erfahrungswissen hin zu wissenschaftlich abgesicherten und evidenzbasierten Behandlungsstrategien entwickelt.
    12/2009: pages 223-266;
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    Susanna Freivogel · Dieter Schmalohr · Jan Mehrholz ·
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    ABSTRACT: To evaluate the effectiveness of repetitive locomotor training using a newly developed electromechanical gait device compared with treadmill training/gait training with respect to patient's ambulatory motor outcome, necessary personnel resources, and discomfort experienced by therapists and patients. Randomized, controlled, cross-over trial. Sixteen non-ambulatory patients after stroke, severe brain or spinal cord injury sequentially received 2 kinds of gait training. Study intervention A: 20 treatments of locomotor training with an electromechanical gait device; control intervention B: 20 treatments of locomotor training with treadmill or task-oriented gait training. The primary variable was walking ability (Functional Ambulation Category). Secondary variables included gait velocity, Motricity-Index, Rivermead-Mobility-Index, number of therapists needed, and discomfort and effort of patients and therapists during training. Gait ability and the other motor outcome related parameters improved for all patients, but without significant difference between intervention types. However, during intervention A, significantly fewer therapists were needed, and they reported less discomfort and a lower level of effort during training sessions. Locomotor training with or without an electromechanical gait trainer leads to improved gait ability; however, using the electromechanical gait trainer requires less therapeutic assistance, and therapist discomfort is reduced.
    Journal of rehabilitation medicine: official journal of the UEMS European Board of Physical and Rehabilitation Medicine 09/2009; 41(9):734-9. DOI:10.2340/16501977-0422 · 1.68 Impact Factor
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    Susanna Freivogel · Jan Mehrholz · Tanya Husak-Sotomayor · Dieter Schmalohr ·
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    ABSTRACT: To evaluate the feasibility of using a newly developed electromechanical gait device (LokoHelp) for locomotion training in neurological patients with impaired walking ability with respect to training effects and patients' and therapists' efforts and discomfort. design: Case series. setting: A neurological rehabilitation centre for children, adolescents and young adults. subjects: Six patients with impaired walking function: two after stroke, two after spinal cord injury and two after brain injury. Intervention: Twenty additional training sessions on a treadmill fitted with a newly developed electromechanical gait device and body weight support (BWS), performed over a study-period of 6 weeks. Patients' progress was assessed with the following instruments: the Functional Ambulation Category FAC (walking ability), the 10-metre walk test (gait velocity), the Motricity Index (lower limb strength), the Berg Balance Scale (postural capacity), the modified Ashworth Scale (spasticity) and the Rivermead Mobility Index (activity). After each therapy session, therapists completed a form, thereby indicating whether manual assistance was necessary and, if so, how much physical effort was expended and how much discomfort was experienced during the therapy session. The therapists also indicated on the form information about the patient's effort and discomfort. No severe adverse events were observed during the locomotion training with the LokoHelp device. Patients improved with regard to Functional Ambulation Category (FAC) (from mean 0.7, SD = 1.6, to mean 2.5, SD = 2.1, p = 0.048), Motricity Index (from mean 94 points, SD = 50, to mean 111, SD = 52, p = 0.086), Berg Balance Scale (BBS) (from mean 20 points, SD = 23 to mean 25, SD = 23, p = 0.168) and Rivermead Mobility Index (RMI) (from mean 5 points, SD = 4, to mean 7, SD = 5, p = 0.033). Therapists required a low level of effort to carry out the training and seldom experienced discomfort. Patients described their effort during training as being low-to-exhausting. They rarely experienced discomfort, which was mostly related to difficulties with the BWS-System. Training intensity had to be adjusted in one patient who complained of knee pain. Locomotion training with the newly developed 'LokoHelp'-system is feasible in severely affected patients after brain injury, stroke and spinal cord injury. In addition, our results indicate that the described alternative method of gait training may decrease the exertion needed by therapists to carry out the training.
    Brain Injury 08/2008; 22(7-8):625-32. DOI:10.1080/02699050801941771 · 1.81 Impact Factor
  • Annette Sterr · Andre Szameitat · Shan Shen · Susanna Freivogel ·
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    ABSTRACT: Basic neuroscience research on brain plasticity, motor learning, and recovery has stimulated new concepts in motor rehabilitation. Combined with the development of methodological goal standards in clinical outcome research, these findings have effectuated the introduction of a double-paradigm shift in physical rehabilitation: (a) the move toward evidence-based procedures and disablement models for the assessment of clinical outcome and (b) the introduction of training-based concepts that are theoretically founded in learning theory. A major drive for new interventions has further come from recent findings on the adaptive capacities of neural networks and their linkage to perception, performance, and long-term recovery. In this context, constraint-induced movement therapy, an intervention initially designed for upper-limb hemiparesis, represents the theoretically and empirically most thoroughly founded training concept. Several clinical trials on constraint-induced therapy (CIT) have shown its efficacy in higher functioning patients; however, the transfer of the treatment into standard health care seems slow. Survey research further suggests a rather poor acceptance of CIT among clinical staff and it seems that the implementation of CIT is hindered by barriers constructed of beliefs and assumptions that demand a critical and evidence-based discussion. Within this context, we have conducted a series of experiments on amended CIT protocols and their application in the clinical environment which addressed the following issues: (1) massed practice: are 6 hours of daily training inevitable to achieve clinical benefits? (2) practicality: what is feasible in the standard care setting and what are the clinical benefits achieved by "feasible compromise CIT protocols?" (3) apprehensions: are concerns on increased muscular tone and pathologic movement patterns justified, and (4) learned nonuse: is the assumption of "hidden" residual abilities valid so that it warrants the constraint condition? In the present paper, the key findings of these studies will be summarized and critically discussed.
    Cognitive and Behavioral Neurology 04/2006; 19(1):48-54. DOI:10.1097/00146965-200603000-00006 · 0.95 Impact Factor
  • A Sterr · S Freivogel ·

    physioscience 08/2005; 2(02):83-84. DOI:10.1055/s-2005-858408
  • Annette Sterr · Susanna Freivogel ·
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    ABSTRACT: The authors assessed whether intensive training increases spasticity and leads to the development of "pathologic movement patterns," a concern often raised by Bobath-trained therapists. The authors used a baseline-control repeated-measures test to study 29 patients with chronic upper limb hemiparesis who received daily shaping training. Their results suggest that training has no adverse effects on muscle tone and movement quality.
    Neurology 01/2005; 63(11):2176-7. DOI:10.1212/01.WNL.0000145605.20476.07 · 8.29 Impact Factor
  • Annette Sterr · Susanna Freivogel ·
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    ABSTRACT: Constraint-induced movement therapy can improve chronic hemiparesis, but this technique has proven difficult to transfer into clinical practice. The authors studied the benefits of a modified regimen designed to be applicable in the clinical environment. Affected arm movements were trained for 90 min/d for 3 weeks using the learning principle "shaping." The outcome measures indicated a significant increase in performance after the intervention compared with the performance during the 3-week baseline interval.
    Neurology 10/2003; 61(6):842-4. DOI:10.1212/WNL.61.6.842 · 8.29 Impact Factor
  • A Sterr · S Freivogel · A Voss ·
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    ABSTRACT: To explore the efficacy of a task-oriented repetitive training protocol (RTx) in chronic hemiparetic patients in an in-patient rehabilitation unit. Three case studies; ABAB design (A=RTx; B=regular rehabilitation programme; 1 week per phase, respectively) in case P1, pre-post intervention comparison in case P2; repeated measure design in case P3. Daily training of task-oriented affected hand movements using shaping procedures developed in Constraint-Induced (CI) Movement Therapy. Patients 1 and 2 were trained daily for 90 minutes over 2 weeks. Patient 3 received 60 minutes of daily training for a period of 4 weeks. Outcome measures were Wolf Motor Function Test (WMFT), Frenchay Arm Test, nine-hole peg test, upper extremity MRC, and grip force. Substantial clinical benefits were achieved in all patients. The subjective observations mirrored significant improvements in the outcome parameters. The affected hand training improves upper limb motor functions in chronic patients. It is a 'practicable' approach for in-patient rehabilitation units.
    Brain Injury 01/2003; 16(12):1093-107. DOI:10.1080/02699050210155267 · 1.81 Impact Factor
  • Annette Sterr · Susanna Freivogel · Dieter Schmalohr ·
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    ABSTRACT: To test the learned nonuse assumption of constraint-induced movement therapy (CIMT), through behavioral assessment, that residual movement abilities are not used to their fullest extent in persons with chronic hemiparesis. Repeated-measures cohort design. Rehabilitation clinic in southwest Germany. Twenty-one persons with upper-limb hemiparesis after brain injury and 21 age-matched healthy controls. Participants were hospitalized when tested. Not applicable. Spontaneous affected hand use for the items of the Motor Activity Log and the Actual Amount of Use Test were compared with the subjects' actual ability to perform these items with the affected hand. A significant difference between the residual movement capability and the spontaneous use was found in both tests. Most movements could be performed with moderate to good movement quality with the affected hand, but were still performed with the unaffected "good" hand in the spontaneous-use condition. This effect was equally strong in right- and left-side affected persons. Hemiparetic persons do not use their residual movement capabilities to the fullest extent. According to the learned nonuse model, this behavior reflects a learned suppression of affected arm movements, which may be overcome by CIMT.
    Archives of Physical Medicine and Rehabilitation 01/2003; 83(12):1726-31. DOI:10.1053/apmr.2002.35660 · 2.57 Impact Factor
  • A. Sterr · D. Schmalohr · S. Kölbel · S. Freivogel ·

    Biomedizinische Technik 01/2001; 46(s2):182-184. DOI:10.1515/bmte.2001.46.s2.182 · 1.46 Impact Factor