F Gerstenbrand

Karl Landsteiner Institut, Wien, Vienna, Austria

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Publications (263)570.56 Total impact

  • Journal of the Neurological Sciences 10/2013; 333:e546. DOI:10.1016/j.jns.2013.07.1919 · 2.26 Impact Factor
  • M. Seidl · S.M. Golaszewski · A.B. Kunz · R. Nardone · G. Bauer · E. Trinka · F. Gerstenbrand
    Journal of the Neurological Sciences 10/2013; 333:e263-e264. DOI:10.1016/j.jns.2013.07.1010 · 2.26 Impact Factor
  • A.B. Kunz · S.M. Golaszewski · J. Hrdy · F. Gerstenbrand
    Pravention und Rehabilitation 01/2013; 25(07):86-94. DOI:10.5414/PRX00442
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    K von Wild · S T Laureys · F Gerstenbrand · G Dolce · G Onose
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    ABSTRACT: In 2002, Bryan Jennett chose the caption “A syndrome in search of a name” for the first chapter of his book “The vegetative state - medical facts, ethical and legal dilemmas”, which, in summary, can be taken as his legacy. Jennett coined the term "VegetativeState" (VS), which became the preferential name for the syndrome of wakeful unresponsiveness in the English literature, with the intention to specify the concern and dilemmas in connection with the naming "vegetative", "persistent" and "permanent". In Europe, Apallic Syndrome (AS) is still in use. The prevalence of VS/AS in hospital settings in Europe is 0.5–2/100.000 population year; one-third traumatic brain damage, 70% following intracranial haemorrhages, tumours, cerebral hypoxemia after cardiac arrest, and end stage of certain progressive neurological diseases. VS/AS reflects brain pathology of (a) consciousness, self-awareness, (b) behaviour, and (c) certain brain structures, so that patients are awake but total unresponsive. The ambiguity of the naming “vegetative” (meant to refer to the preserved vegetative (autonomous nervous system) can suggest that the patient is no more a human but “vegetable” like. And “apallic” does not mean being definitively and completely anatomically disconnected from neocortical structures. In 2009, having joined the International Task Force on the Vegetative State, we proposed the new term “Unresponsive Wakefulness Syndrome” (UWS) to enable (neuro-)scientists, the medical community, and the public to assess and define all stages accurately in a human way. The Unresponsive Wakefulness Syndrome (UWS) could replace the VS/AS nomenclature in science and public with social competence.
    Journal of medicine and life 02/2012; 5(1):3-15.
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    ABSTRACT: Traumatic Brain Injury (TBI) is among the most frequent neurological disorders. Of all TBIs 90% are considered mild with an annual incidence of 100–300/100.000. Intracranial complications of Mild Traumatic Brain Injury (MTBI) are infrequent (10%), requiring neurosurgical intervention in a minority of cases (1%), but potentially life-threatening (case fatality rate 0,1%). Hence, a true health management problem exists because of the need to exclude the small chance of a life threatening complication in large numbers of individual patients. The 2002 EFNS guidelines used a best evidence approach based on the literature until 2001 to guide initial management with respect to indications for CT, hospital admission, observation and follow up of MTBI patients. This updated EFNS guideline version for initial management inMTBI proposes a more selectively strategy for CT when major (dangerous mechanism, GCS<15, 2 points deterioration on the GCS, clinical signs of (basal) skull fracture, vomiting, anticoagulation therapy, post traumatic seizure) or minor (age, loss of consciousness, persistent anterograde amnesia, focal deficit, skull contusion, deterioration on the GCS) risk factors are present based on published decision rules with a high level of evidence. In addition clinical decision rules for CT now exist for children as well. Since 2001 recommendations, although with a lower level of evidence, have been published for clinical in hospital observation to prevent and treat other potential threads to the patient including behavioral disturbances (amnesia, confusion and agitation) and infection.
    European Journal of Neurology 02/2012; 19(2):191-8. DOI:10.1111/j.1468-1331.2011.03581.x · 4.06 Impact Factor
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    ABSTRACT: Although chronic sleepiness is common after head trauma, the cause remains unclear. Transcranial magnetic stimulation (TMS) represents a useful complementary approach in the study of sleep pathophysiology. We aimed to determine in this study whether post-traumatic sleep-wake disturbances (SWD) are associated with changes in excitability of the cerebral cortex. TMS was performed 3 months after mild to moderate traumatic brain injury (TBI) in 11 patients with subjective excessive daytime sleepiness (EDS; defined by the Epworth Sleepiness Scale ≥10), 12 patients with objective EDS (as defined by mean sleep latency <5 on multiple sleep latency tests), 11 patients with fatigue (defined by daytime tiredness without signs of subjective or objective EDS), 10 patients with post-traumatic hypersomnia "sensu strictu," and 14 control subjects. Measures of cortical excitability included central motor conduction time, resting motor threshold (RMT), short-latency intracortical inhibition (SICI), and intracortical facilitation to paired-TMS. RMT was higher and SICI was more pronounced in the patients with objective EDS than in the control subjects. In the other patients all TMS parameters did not differ significantly from the controls. Similarly to that reported in patients with narcolepsy, the cortical hypoexcitability may reflect the deficiency of the excitatory hypocretin/orexin-neurotransmitter system. These observations may provide new insights into the causes of chronic sleepiness in patients with TBI. A better understanding of the pathophysiology of post-traumatic SWD may also lead to better therapeutic strategies in these patients.
    Journal of neurotrauma 03/2011; 28(7):1165-71. DOI:10.1089/neu.2010.1748 · 3.97 Impact Factor
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    G. Bauer · S. Golaszewski · Franz Gerstenbrand
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    ABSTRACT: 1966 prägten Plum und Posner [1] den Terminus Locked-In-Syndrom (LiS). „Locked in“ bedeutet Eingesperrtsein. Das LiS bezeichnet topologisch ein ventrales Brückensyndrom, das klinisch durch eine komplette Lähmung bei erhaltenem Bewusstsein gekennzeichnet ist. Lediglich vertikale Blick- und Blinzelbewegungen sind willentlich möglich. Vom LiS im eigentlichen Sinne sind Zustände weitgehender Immobilität wie bei schwerem Guillain-Barré-Syndrom, bei fortgeschrittener Amyotropher Lateralsklerose, bei Morbus Parkinson, bei Multipler Sklerose, bei Alzheimerscher Demenz und bei anderen progredienten neurologischen Erkrankungen zu unterscheiden. Die diagnostische Abgrenzung dieser Zustände vom LiS ist aufgrund der Krankengeschichte unschwer möglich und in prognostischer Hinsicht wichtig, da LiS in einigen Fällen vollständig oder teilweise reversibel und meist nicht progredient ist. Totale Immobilität bei erhaltenem Bewusstsein stellt eine existentielle Extrem-situation dar und hat dementsprechend großes mediales Interesse erfahren. Dabei ist die Abgrenzung zu Reintegrationsstufen eines apallischen Syndroms (vegetativer Zustand) im Sinne eines so genannten minimal bewussten Zustandes [2] zumindest in der veröffentlichten Meinung nicht genügend beachtet worden.
    Psychopraxis 01/2010; 13(5):18-22. DOI:10.1007/s00739-010-0256-y
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    ABSTRACT: The aim of the present was study to evaluate cortical and subcortical neural responses on vibrotactile stimulation of the food and to assess somatosensory evoked BOLD responses in dependence of vibration amplitude and stimulus waveform. Sixteen healthy male subjects received vibrotactile stimulation at the sole of the right foot. The vibration stimulus was delivered through a moving magnet actuator system (MMAS). In an event-related design, a series of vibration stimuli with a duration of 1 s and a variable interstimulus interval was presented. Four stimulation conditions were realized using a 2 (amplitudes 0.4 mm or 1.6 mm) x 2 (waveform sinusoidal or amplitude modulated) factorial design. Stimulating with 0.4 mm amplitude compared to 1.6 mm stimulus amplitude more strongly activated the pre- and postcentral gyrus bilaterally and the right inferior, medial and middle frontal gyrus. In the reverse comparison significant differences were observed within the left inferior parietal lobule, the left superior temporal gyrus, and the left temporal transverse gyrus. In the comparison of sinusoidal versus modulated waveform and vice versa no significant activation differences were obtained. The inter-subject variability was high but when all four stimulation conditions were jointly analyzed, a significant activation of S1 was obtained for every single subject. This study demonstrated that the BOLD response is modulated by the amplitude but not by the waveform of vibrotactile stimulation. Despite high inter-individual variability, the stimulation yielded reliable results for S1 on the single-subject level. Therefore, our results suggest that vibrotactile testing could evolve into a clinical tool in functional neuroimaging.
    NeuroImage 07/2008; 41(2):504-10. DOI:10.1016/j.neuroimage.2008.02.049 · 6.36 Impact Factor
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    European Handbook of Neurological Management, 01/2008: pages 207 - 223; , ISBN: 9780470753279
  • Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Österreichischer Nervenärzte und Psychiater 01/2008; DOI:10.5414/NEPBand21226 · 1.38 Impact Factor
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    ABSTRACT: Spasticity is often a handicap in paraplegics and interferes with quality of life. Medical therapeutic options (e.g. baclofen, tizanidin) lead to drowsiness, fatigue and loss in activity. On the other hand paraplegics are increasingly active in daily life and leisure (paralympics). Neurorehabilitation is effective in reduction of spasticity, gaining motor function and enhancing quality of life. Hippotherapy (Lechner et al 2003) and aquatic rehabilitation are additive methods. Already 15 years ago Madorsky et al pointed out SCUBA diving as a positive neurorehabilitation procedure. The study group around Stanghelle reported also beneficial aspects on spasticity of patients with spinal cord injuries. These references inspired to introduce a prospective study. After obtaining an ethic votum and evaluation assessment for diving permission 6 volunteers with paraplegia entered the pilot study. Medication was kept stable throughout the study time. Supervised by diving instructors and a diving trained doctor the volunteers dived to a platform in the depth of 7.2 meters. The daily diving time was exactly 30 minutes. Stabilized on the platform physiotherapeutic assessment took place in different positions to reduce spasticity. Ashworth Scale and spasm frequency scale were noted daily and at beginning and end of the study the WHO Quality of life Test had to be completed. For objective reasons a locomat training happened before, within a week after and 4 weeks after the study week. All patients did the daily dives without any difficulties. The statistics included the assessment of day 1 versus day 7 of 5 patients and showed a significant reduction of Modified Ashwoth Scale (p=0.04). Quality of life showed an improvement. The improvement rationale can only be supposed. A correlation to the ambient pressure suggests itself. Therefore deeper depths should increase the good spasticity results or manage to achieve those faster. Many questions remain, so further studies are necessary to ascertain the ideal standard options.
    Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Österreichischer Nervenärzte und Psychiater 02/2007; 21(3):226-9. · 1.38 Impact Factor
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    ABSTRACT: Introduction: Epidemiology in Europe shows constantly increasing figures for the apallic syndrome (AS)/vegetative state (VS) as a consequence of advanced rescue, emergency services, intensive care treatment after acute brain damage and high-standard activating home nursing for completely dependent end-stage cases secondary to progressive neurological disease. Management of patients in irreversible permanent AS/VS has been the subject of sustained scientific and moral-legal debate over the past decade. Methods: A task force on guidelines for quality management of AS/VS was set up under the auspices of the Scientific Panel Neurotraumatology of the European Federation of Neurological Societies to address key issues relating to AS/VS prevalence and quality management. Collection and analysis of scientific data on class II (III) evidence from the literature and recommendations based on the best practice as resulting from the task force members' expertise are in accordance with EFNS Guidance regulations. Findings: The overall incidence of new AS/VS full stage cases all etiology is 0.5–2/100.000 population per year. About one third are traumatic and two thirds non traumatic cases. Increasing figures for hypoxic brain damage and progressive neurological disease have been noticed. The main conceptual criticism is based on the assessment and diagnosis of all different AS/VS stages based solely on behavioural findings without knowing the exact or uniform pathogenesis or neuropathological findings and the uncertainty of clinical assessment due to varying inclusion criteria. No special diagnostics, no specific medical management can be recommended for class II or III AS treatment and rehabilitation. This is why sine qua non diagnostics of the clinical features and appropriate treatment of AS/VS patients of “AS full, remission, defect and end stages” require further professional training and expertise for doctors and rehabilitation personnel. Interpretation: Management of AS aims at the social reintegration of patients or has to guarantee humanistic active nursing if treatment fails. Outcome depends on the cause and duration of AS/VS as well as patient's age. There is no single AS/VS specific laboratory investigation, no specific regimen or stimulating intervention to be recommended for improving higher cerebral functioning. Quality management requires at least 3 years of advanced training and permanent education to gain approval of qualification for AS/VS treatment and expertise. Sine qua non areas covering AS/VS institutions for early and long-term rehabilitation are required on a population base (prevalence of 2/100.000/year) to quicken functional restoration and to prevent or treat complications. Caring homes are needed for respectful humane nursing including basal sensor-motor stimulating techniques. Passive euthanasia is considered an act of mercy by physicians in terms of withholding treatment; however, ethical and legal issues with regard to withdrawal of nutrition and hydration and end of life discussions raise deep concerns. The aim of the guideline is to provide management guidance (on the best medical evidence class II and III or task force expertise) for neurologists, neurosurgeons, other physicians working with AS/VS patients, neurorehabilitation personnel, patients, next-of-kin, and health authorities.
    European Journal of Trauma and Emergency Surgery 01/2007; 33(3):268-292. DOI:10.1007/s00068-007-6138-1 · 0.38 Impact Factor
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    ABSTRACT: To study cerebral responses evoked from mechanoreceptors in the human foot sole using a computer-controlled vibrotactile stimulation system. The stimulation system consisted of two stationary moving magnet actuators with indentors to gently contact and vibrate the foot sole during functional MRI (fMRI) experiments. To allow independent settings of contact force (0-20 N) and intensity of vibration (frequency range=20-100 Hz) the actuators were controlled by a digital servo loop. For fMRI experiments with complex stimulus protocols, both vibrating probes were further operated under supervisory control. The MR compatibility of this electromagnetic system was tested in a 1.5T scanner with an actively shielded magnet (Siemens Magnetom Sonata). Blood oxygenation level-dependent (BOLD) responses were detected in the contralateral left pre- and postcentral gyrus, bilaterally within the secondary somatosensory cortex, bilaterally within the supplementary motor cortex, and bilaterally within the anterior cingular gyrus. This stimulation device provides a new tool for identifying cerebral structures that convey sensory information from the foot region, which is of promising diagnostic value, particularly for assessing sensorimotor deficits resulting from brain lesions.
    Journal of Magnetic Resonance Imaging 11/2006; 24(5):1177-82. DOI:10.1002/jmri.20742 · 2.79 Impact Factor
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    ABSTRACT: The purpose of this study was to investigate the sensorimotor cortex response to plantar vibrotactile stimulation using a newly developed MRI compatible vibration device. Ten healthy subjects (20-45 years) were investigated. Vibrotactile stimulation of the sole of the foot with a frequency of 50 Hz and a displacement of 1 mm was performed during fMRI (echo-planar imaging sequence at 1.5 T) using an MRI compatible moving magnet actuator that is able to produce vibration frequencies between 0 and 100 Hz and displacement amplitudes between 0 and 4 mm. The fMRI measurement during vibrotactile stimulation of the right foot revealed brain activation contralaterally within the primary sensorimotor cortex, bilaterally within the secondary somatosensory cortex, bilaterally within the superior temporal, inferior parietal, and posterior insular region, bilaterally within the anterior and posterior cingular gyrus, bilaterally within the thalamus and caudate nucleus, contralaterally within the lentiform nucleus, and bilaterally within the anterior and posterior cerebellar lobe. The advantages of the new MRI compatible vibration device include effective transmission of the stimulus and controlled vibration amplitudes, frequencies, and intensities. The results indicate that plantar vibration can be a suitable paradigm to observe activation within the sensorimotor network in fMRI. Furthermore, the method may be used to determine the optimal responsiveness of the individual sensorimotor network.
    NeuroImage 03/2006; 29(3):923-9. DOI:10.1016/j.neuroimage.2005.08.052 · 6.36 Impact Factor
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    ABSTRACT: To investigate sensory and motor functions in microgravity, goal-oriented arm movements were performed by 9 cosmonauts in weightlessness. The ability to reproduce predefined motor patterns was examined pre-, in-, and post-flight under two different paradigms: In a first test, the cosmonaut had to reproduce passively learned movements with eyes closed, while in the second test, the cosmonaut learned the pattern with eyes open. The different learning paradigms effected the metric parameters of the memorized stimulus pattern while the influence of the different gravity levels resulted in significant offsets and torsions of the reproduced figures. In comparing the inflight condition with preflight, intact proprioceptive afference seemed to play an important role for reproducing movements from motor short-time memory correctly.
    Journal of gravitational physiology: a journal of the International Society for Gravitational Physiology 08/2004; 11(2):P115-7.
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    K Minassian · B Jilge · F Rattay · M M Pinter · H Binder · F Gerstenbrand · M R Dimitrijevic
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    ABSTRACT: It has been previously demonstrated that sustained nonpatterned electric stimulation of the posterior lumbar spinal cord from the epidural space can induce stepping-like movements in subjects with chronic, complete spinal cord injury. In the present paper, we explore physiologically related components of electromyographic (EMG) recordings during the induced stepping-like activity. To examine mechanisms underlying the stepping-like movements activated by electrical epidural stimulation of posterior lumbar cord structures. The study is based on the assessment of epidural stimulation to control spasticity by simultaneous recordings of the electromyographic activity of quadriceps, hamstrings, tibialis anterior, and triceps surae. We examined induced muscle responses to stimulation frequencies of 2.2-50 Hz in 10 subjects classified as having a motor complete spinal cord injury (ASIA A and B). We evaluated stimulus-triggered time windows 50 ms in length from the original EMG traces. Stimulus-evoked compound muscle action potentials (CMAPs) were analyzed with reference to latency, amplitude, and shape. Epidural stimulation of the posterior lumbosacral cord recruited lower limb muscles in a segmental-selective way, which was characteristic for posterior root stimulation. A 2.2 Hz stimulation elicited stimulus-coupled CMAPs of short latency which were approximately half that of phasic stretch reflex latencies for the respective muscle groups. EMG amplitudes were stimulus-strength dependent. Stimulation at 5-15 and 25-50 Hz elicited sustained tonic and rhythmic activity, respectively, and initiated lower limb extension or stepping-like movements representing different levels of muscle synergies. All EMG responses, even during burst-style phases were composed of separate stimulus-triggered CMAPs with characteristic amplitude modulations. During burst-style phases, a significant increase of CMAP latencies by about 10 ms was observed. The muscle activity evoked by epidural lumbar cord stimulation as described in the present study was initiated within the posterior roots. These posterior roots muscle reflex responses (PRMRRs) to 2.2 Hz stimulation were routed through monosynaptic pathways. Sustained stimulation at 5-50 Hz engaged central spinal PRMRR components. We propose that repeated volleys delivered to the lumbar cord via the posterior roots can effectively modify the central state of spinal circuits by temporarily combining them into functional units generating integrated motor behavior of sustained extension and rhythmic flexion/extension movements. This study opens the possibility for developing neuroprostheses for activation of inherent spinal networks involved in generating functional synergistic movements using a single electrode implanted in a localized and stable region.
    Spinal Cord 08/2004; 42(7):401-16. DOI:10.1038/sj.sc.3101615 · 1.70 Impact Factor
  • B Jilge · K Minassian · F Rattay · M M Pinter · F Gerstenbrand · H Binder · M R Dimitrijevic
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    ABSTRACT: We provide evidence that the human spinal cord is able to respond to external afferent input and to generate a sustained extension of the lower extremities when isolated from brain control. The present study demonstrates that sustained, nonpatterned electrical stimulation of the lumbosacral cord--applied at a frequency in the range of 5-15 Hz and a strength above the thresholds for twitches in the thigh and leg muscles--can initiate and retain lower-limb extension in paraplegic subjects with a long history of complete spinal cord injury. We hypothesize that the induced extension is due to tonic input applied by the epidural stimulation to primary sensory afferents. The induced volleys elicit muscle twitches (posterior root muscle-reflex responses) at short and constant latency times and coactivate the configuration of the lumbosacral interneuronal network, presumably via collaterals of the primary sensory neurons and their connectivity with this network. We speculate that the volleys induced externally to the lumbosacral network at a frequency of 5-15 Hz initiate and retain an "extension pattern generator" organization. Once established, this organization would recruit a larger population of motor units in the hip and ankle extensor muscles as compared to the flexors, resulting in an extension movement of the lower limbs. In the electromyograms of the lower-limb muscle groups, such activity is reflected as a characteristic spatiotemporal pattern of compound motor-unit potentials.
    Experimental Brain Research 03/2004; 154(3):308-26. DOI:10.1007/s00221-003-1666-3 · 2.17 Impact Factor
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    ABSTRACT: The human motor system responds to weightlessness by the slowing of movement. It has been suggested that deficits in visuo-motor co-ordination cause this effect. We studied the mechanisms of the slowing of movement in three long-term missions to the Russian space station Mir. In particular, the role of vision in the control of movement in microgravity has been studied in these experiments on seven cosmonauts, pre-, in-, and post-flight. The cosmonauts made arm movements to visual targets under the following conditions of visual control: no visual control, interrupted visual control, and undisturbed visual control. The results showed that the slowing of movement during weightlessness was manifested by decreases of peak velocity and peak acceleration, was not associated with a prolongation of the movement phase of deceleration, and was not affected by manipulation of the conditions of visual control. The slowing of movement tended to subside after the months of the flight and completely disappeared within days after the landing. Accuracy of the movements strictly depended on the constraints imposed on the vision and remained unaffected in-flight. The data presented demonstrate that the slowing of movement in microgravity is not directly related to deficits in sensori-motor co-ordination and is not associated with a reduction of the accuracy of movement. The strategy for motor control in microgravity seems to be directed towards the generation of smooth movements and the maintenance of their accuracy.
    Arbeitsphysiologie 11/2002; 87(6):576-83. DOI:10.1007/s00421-002-0684-3 · 2.30 Impact Factor
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    ABSTRACT: In 1999, a Task Force on Mild Traumatic Brain Injury (MTBI) was set up under the auspices of the European Federation of Neurological Societies. Its aim was to propose an acceptable uniform nomenclature for MTBI and definition of MTBI, and to develop a set of rules to guide initial management with respect to ancillary investigations, hospital admission, observation and follow-up.
    European Journal of Neurology 06/2002; 9(3):207-19. DOI:10.1046/j.1468-1331.2002.00407.x · 3.85 Impact Factor
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    ABSTRACT: In this study we examined EMG responses of lower limb muscles to repetitive electrical stimulation of the human lumbar cord isolated from brain control. We found that the muscle activity elicited at low frequencies (2 Hz) are monosynaptic posterior root muscle reflexes. A sustained train of stimuli at higher frequencies (16 Hz or more) establishes longer spinal reflex pathways involving interneuronal networks, the monosynaptic EMG response is progressively replaced by a second response with longer but also constant latency. When the frequency is further increased to 30-50 Hz, a locomotor-like EMG activity can be induced, and the amplitude and occurrence of the second response progressively augments. During the bursting phases of rhythmical EMG activity the amplitude of the first monosynaptic response is completely suppressed. Our study suggests, that the driving input from brain structures can be replaced artificially by a non-patterned input via the posterior roots and interpreted by the lumbar interneuronal network to respond with a patterned, rhythmical activity.

Publication Stats

2k Citations
570.56 Total Impact Points

Institutions

  • 2011–2013
    • Karl Landsteiner Institut
      Wien, Vienna, Austria
  • 2012
    • University of Münster
      • Medical Faculty
      Muenster, North Rhine-Westphalia, Germany
  • 2010
    • Medizinische Universität Innsbruck
      Innsbruck, Tyrol, Austria
  • 1970–2007
    • University of Innsbruck
      • Institute of Biochemistry
      Innsbruck, Tyrol, Austria
  • 2004
    • Ludwig Boltzmann Institute for Osteology
      Wien, Vienna, Austria
  • 1994
    • Slovak Medical University in Bratislava
      Presburg, Bratislavský, Slovakia
  • 1993
    • Baylor College of Medicine
      Houston, Texas, United States
  • 1991
    • Vienna University of Technology
      Wien, Vienna, Austria
    • Sapienza University of Rome
      Roma, Latium, Italy
  • 1964–1983
    • University of Vienna
      • Department of Medicinal Chemistry
      Wien, Vienna, Austria