Joachim Liepert

• Kliniken Schmieder Heidelberg

Die Bandbreite neurologisch bedingter Gangstörungen reicht von leichten Unsicherheiten beim Gehen bis hin zu schwerwiegenden Beeinträchtigungen, die unter anderem das Sturzrisiko deutlich erhöhen. Neben klinischen Gehtests gibt es gute technologiebasierte Ganganalysesysteme. Jedoch werden sie aufgrund des damit verbundenen Mehraufwands nur selten g...

Die Wiederherstellung der Gehfähigkeit ist ein zentrales Ziel in der Rehabilitation von Patientinnen und Patienten mit neurologischen Erkrankungen. Die Bandbreite der neurologisch bedingten Gangstörungen reicht von leichten Unsicherheiten beim Gehen bis hin zu schwerwiegenden Beeinträchtigungen, die auch das Sturzrisiko deutlich erhöhen. Neben klin...

Introduction: Clinical gait analysis plays a central role in the rehabilitation of stroke patients. However, practical and technical challenges limit their use in clinical settings. This study aimed to validate SMARTGAIT, a deep learning-based gait analysis system that addresses these limitations. Methods: Eight stroke patients took part in the stu...

Background Gait deficits are very common after stroke and therefore an important aspect in poststroke rehabilitation. A currently little used method in gait rehabilitation after stroke is the activation of the flexor reflex (FR) by electrical stimulation of the sole of foot while walking. The aim of this study was to investigate the effect of FR st...

Background The prevalence of neurological disorders is increasing, underscoring the importance of objective gait analysis to help clinicians identify specific deficits. Nevertheless, existing technological solutions for gait analysis often suffer from impracticality in daily clinical use, including excessive cost, time constraints, and limited proc...

Whenever we are confronted with action opportunities in everyday life, e.g., when passing an opening, we rely on our ability to precisely estimate our own bodily capabilities in relation to the environmental conditions. So-called affordance judgments can be affected after brain damage. Previous studies with healthy adults showed that such judgments...

Background: Neurological injuries, such as stroke, often lead to motor and somatosensory impairments of the hand. Deficits in somatosensation, especially proprioception, result in difficulties performing activities of daily living involving fine motor tasks. As those impairments are challenging to accurately evaluate and monitor, therapies rarely f...

Background Hand proprioception is essential for fine movements and therefore many activities of daily living. Although frequently impaired after stroke, it is unclear how hand proprioception evolves in the sub-acute phase and whether it follows a similar pattern of changes as motor impairments. Objective This work investigates whether there is a c...

Background: Motor imagery (MI) can serve as a treatment for stroke rehabilitation. MI abilities can be assessed by testing mental chronometry (MC) as the degree of conformity between imagined and real performance of a task. A good MC performance is supposed to indicate good MI capacities. Objective: To explore if MC abilities can be modified by...

Background Somatosensory deficits after stroke correlate with functional disabilities and impact everyday-life. In particular, the interaction of proprioception and motor dysfunctions affects the recovery. While corticospinal tract (CST) damage is linked to poor motor outcome, much less is known on proprioceptive recovery. Identifying a predictor f...

Background Gait deficits are very common after stroke and therefore an important aspect in poststroke rehabilitation. A currently little used method in gait rehabilitation after stroke is the activation of the flexor reflex (FR) by electrical stimulation of the sole of foot while walking. The aim of this study was to investigate the effect of FR st...

Objective To characterize motor excitability changes and changes of motor performance induced by a single anodal and cathodal transcranial direct current stimulation (tDCS) session in stroke patients. Methods Twenty subacute stroke patients participated. Motor performance was tested with the Box and Block Test [BBT]. Motor cortex excitability (sho...

Neurological injuries such as stroke often lead to motor and somatosensory impairments of the hand. Deficits in somatosensation, especially proprioception, result in difficulties performing activities of daily living involving fine motor tasks. However, it is challenging to accurately detect those impairments due to the limitations of clinical asse...

Background Stroke is one of the most frequent diseases, and half of the stroke survivors are left with permanent impairment. Prediction of individual outcome is still difficult. Many but not all patients with stroke improve by approximately 1.7 times the initial impairment, that has been termed proportional recovery rule. The present study aims at...

100 years ago, Liepmann highlighted the role of left ventro-dorsal lesions for impairments in conceptual (rather ventral) and motor (more dorsal) related aspects of apraxia. Many studies thereafter attributed to an extended left fronto-temporo-parietal network. Yet, to date there are only few studies that looked at apraxic performance in the select...

Background: Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional...

The flexor reflex or withdrawal reflex can be elicited by electrical stimulation of the sole of the foot, which serves as a reflex to protect the stimulated limb against tissue damage and consists of flexion movements in the hip, knee, and ankle joint. Triggering this reflex might improve walking abilities in hemiparetic patients. We report the fir...

Background Physical training is able to induce changes at neurophysiological and behavioral level associated with performance changes for the trained movements. The current study explores the effects of an additional intense robot-assisted upper extremity training on functional outcome and motor excitability in subacute stroke patients. Methods Th...

Background: Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional c...

Background Motor imagery training might be helpful in stroke rehabilitation. This study explored if a single session of motor imagery (MI) training induces performance changes in mental chronometry (MC), motor execution, or changes of motor excitability. Methods Subacute stroke patients ( n = 33) participated in two training sessions. The order wa...

Left hemisphere stroke frequently leads to limb apraxia, a disorder that has been reported to impact independence in daily life and rehabilitation success. Nonetheless, there is a shortcoming in research and availability of applicable trainings. Further, to date, anosognosia for limb apraxia has largely been neglected. Therefore, we developed a Nat...

Hand function is often impaired after neurological injuries such as stroke. In order to design patient-specific rehabilitation, it is essential to quantitatively assess those deficits. Current clinical scores cannot provide the required level of detail, and most assessment devices have been developed for the proximal joints of the upper limb. This...

Objective: Limb apraxia is a motor cognitive disorder that has been mainly studied in patients with dementia or left hemisphere stroke (LHS). However, limb apraxia has also been reported in patients with right hemisphere stroke (RHS), multiple sclerosis (MS) or traumatic brain injury (TBI). This study’s aim was to report detailed praxis performance...

Background: Motor deficits are the most common symptoms after stroke. There is some evidence that intensity and amount of exercises influence the degree of improvement of functions within the first 6 months after the injury. The purpose of this pilot study was to evaluate the feasibility and acceptance of semi-autonomous exercises with an upper ex...

Background: Proprioceptive function can be affected after neurological injuries such as stroke. Severe and persistent proprioceptive impairments may be associated with a poor functional recovery after stroke. To better understand their role in the recovery process, and to improve diagnostics, prognostics, and the design of therapeutic intervention...

In neurological patients, a lack of insight into their impairments can lead to possibly dangerous situations and non-compliance in rehabilitation therapy with worse rehabilitation outcomes as a result. This so called anosognosia is a multifaceted syndrome that can occur after brain damage affecting different neurological or cognitive functions. To...

Please cite: Randerath J., Buchmann I., Liepert J. & Büsching I. (2017). Diagnostic Instrument for Limb Apraxia (DILA-S). Manual (1st edition). University of Konstanz and Lurija Institute. Konstanz, Germany. For more material see: https://www.moco.uni-konstanz.de/publikationen/assessments/

Please cite: Randerath J., Buchmann I., Liepert J. & Büsching I. (2017). Diagnostic Instrument for Limb Apraxia (DILA-S). Manual (1st edition). University of Konstanz and Lurija Institute. Konstanz, Germany. For more material see: https://www.moco.uni-konstanz.de/publikationen/assessments/

Neurological injuries such as stroke can lead to proprioceptive impairment. For an informed diagnosis, prognosis, and treatment planning, it is essential to be able to distinguish between healthy performance and deficits following the neurological injury. Since there is some evidence that proprioception declines with age and stroke occurs predomina...

Not much is known about how well stroke patients are able to perform motor imagery (MI) and which MI abilities are preserved after stroke. We therefore applied three different MI tasks (one mental chronometry task, one mental rotation task, and one EEG-based neurofeedback task) to a sample of postacute stroke patients ( n=20 ) and age-matched healt...

Background: Electrical stimulation has been used in stroke patients to improve motor deficits, mostly by neuromuscular stimulation. In this study, we applied passive repetitive electrical stimulation to the fingertips using an intermittent, high-frequency stimulation protocol. The aim of this placebo-controlled pilot study was to evaluate the feasi...

Dank der Fortschritte der modernen Medizin ist die unmittelbare Mortalitätsrate nach einem Schlaganfall in den vergangenen Jahrzehnten kontinuierlich gesunken. Kehrseite dieser Entwicklung ist, dass die den Schlaganfall überlebenden Patienten für die verbliebene Lebensspanne teilweise erhebliche funktionelle motorische und/oder sprachliche Einschrä...

Objective: Biallelic mutations in the AP5Z1 gene encoding the AP-5 ζ subunit have been described in a small number of patients with hereditary spastic paraplegia (HSP) (SPG48); we sought to define genotype–phenotype correlations in patients with homozygous or compound heterozygous sequence variants predicted to be deleterious. Methods: We performe...

Background: Motor imagery is used for treatment of motor deficits after stroke. Clinical observations suggested that motor imagery abilities might be reduced in patients with severe sensory deficits. This study investigated the influence of somatosensory deficits on temporal (mental chronometry, MC) and spatial aspects of motor imagery abilities....

Seit ca. 20 Jahren werden kontrollierte randomisierte Studien mit unterschiedlichen Medikamenten durchgeführt, um die motorische Funktionsrestitution nach einem Schlaganfall zu unterstützen. Bislang zeigen Serotoninwiederaufnahmehemmer mit der größten Anzahl positiv verlaufener Studien die deutlichste Evidenz einer Wirksamkeit. Auch für L‑Dopa erge...

Purpose of review: This article evaluates whether specific drugs are able to facilitate motor recovery after stroke or improve the level of consciousness, cognitive, or behavioral symptoms after traumatic brain injury. Recent findings: After stroke, serotonin reuptake inhibitors can enhance restitution of motor functions in depressed as well as...

Mentales Training – Bewegungsbeobachten und insbesondere Bewegungsvorstellung – hat viel akademisches Interesse geweckt. Die funktionelle Äquivalenz von Bewegungsvorstellung und Bewegungsausführung lässt hoffen, dass sich mentales Training zur motorischen Rehabilitation nach einem Schlaganfall nutzen lässt. Mittlerweile stehen randomisierte kontrol...

Motor function and motor excitability can be modulated by changes of somatosensory input. Here, we performed a randomized single-blind trial to investigate behavioral and neurophysiological changes during temporary deafferentation of left upper arm and forearm in 31 right-handed healthy adults. Lidocaine cream was used to anesthetize the skin from...

Conversion (functional) limb weakness or paralysis (FW) can be a debilitating condition, and often causes significant distress or impairment in social, occupational, or other important areas of functioning. Most treatment concepts are multi-disciplinary, containing a behavioral approach combined with a motor learning program. Non-invasive brain sti...

Background: After ischemic stroke, many factors influence the restitution of functions. In particular they include the patient age, the initial stroke severity and the presence of cognitive and neuropsychological deficits. In this study we investigated whether a polymorphism in the gene encoding for brain derived neurotrophic factor (BDNF) influen...

Background Mental practice has been used in neurologic rehabilitation to improve motor performance. This study explored if mental practice targeting the hand modulates cortical excitability and improves function of the affected hand. Transcranial Magnetic Stimulation (TMS) was used to measure changes in the duration of the cortical Silent Period (c...

Objective: To explore whether stroke patients exhibit increases in motor excitability during action observation, whether differences exist between the affected and non-affected sides, and between pure motor strokes and predominantly sensory strokes. Methods: In 18 patients (10 pure motor strokes, 8 predominantly sensory strokes, < 6 months after...

Objective: This study examined the temporal congruency between real and imagined movements and explored intermanual transfer effects in healthy subjects. Methods: Seventy-six right-handed healthy subjects were allocated to three age groups and tested with a modified version of the Box and Block Test (BBT). We focussed on two aspects. First, the...

To explore motor excitability changes induced by disobedience and feigning-like behaviour. Healthy subjects participated in motor imagery tasks. They imagined either a maximum muscle relaxation (condition 1) or a pinch grip (condition 2). In other trials, they were instructed to disobey the command to imagine a pinch grip. Instead, they should eith...

Background: To explore whether a polymorphism in dopamine metabolism influences the effectiveness of neurological rehabilitation and the outcome after ischemic stroke. Methods: The Barthel Index (BI) and the Rivermead Motor Assessment (RMA) were assessed in 78 moderately affected stroke patients (1) after they had entered a neurological inpatien...

In this review, treatments for motor rehabilitation after stroke will be presented. In particular, randomised, controlled trials, meta-analyses and systematic reviews, mainly from the years 2009 - 2011, were taken into consideration. In summary, evidence is best for constraint-induced movement therapy and Botulinum toxin type A in patients with foc...

When motor imagery (MI) is impaired in stroke patients, it is not clear, whether this is caused by the central lesion with a disruption of networks or this may be due to inactivity/lack of practice following hemiparesis. To answer this question, we investigated MI in two groups of patients: stroke patients and patients with no central lesion, who s...

Motor imagery (MI) is increasingly recognized as a treatment option after stroke, but not all stroke patients are able to perform MI. To examine if severe somatosensory deficits would affect MI ability. The Box and Block Test (BBT) was used to evaluate mental chronometry as 1 component of MI. Two groups of stroke patients and an age-matched healthy...

Aim: The study's aim was to investigate stroke patients' acceptance of mental imagery training. We also examined whether mental imagery improves through training. Patients and methods: Fourteen patients with a stroke and a hand paresis were included. The intervention lasted for 45 minutes sessions on 8 consecutive week days as add-on therapy during...

Objective: Constraint-Induced Movement Therapy (CIMT) has been shown to be effective in improving use of the affected arm after stroke. Since paresis of the lower extremity after stroke also reduces the quality of life, a comparable rehabilitation therapy for that extremity is required to improve mobility and independence. The aim of this pilot stu...

Die gesundheitspolitische und gesellschaftspolitische Bedeutung der Neurorehabilitation wurde in Deutschland früh erkannt, entsprechend wurden flächendeckend Neurorehabilitationsstrukturen geschaffen. Dies geschah mit der Etablierung indikationsspezifischer Rehabilitationseinrichtungen, im Weiteren zunehmend auch in Frührehabilitationseinrichtungen...

Patients with a psychogenic paresis have difficulties performing voluntary movements. Typically, diagnostic interventions are normal. We tested whether patients with a psychogenic lower limb paresis exhibit abnormal motor excitability during motor imagery or movement observation. Transcranial magnetic stimulation (TMS) with single and paired pulses...

Das Bobath-Konzept ist eine lösungsorientierte Vorgehensweise bei der Befundaufnahme und Behandlung von Individuen mit funktionellen Störungen, Bewegungsstörungen und Störungen der posturalen Kontrolle aufgrund einer Läsion des zentralen Nervensystems (IBITA 1996; Panturin 2001; Brock et al. 2002; Raine 2006). Dieser Ansatz zur Rehabilitation Erwac...

The diversity of interventions aimed at improving upper extremity dysfunction is increasing. This article reviews the effectiveness of different therapeutic approaches that have been published in 2009 and 2010. Evidence is based on randomized controlled trials, systematic reviews, and meta-analyses. Application of constraint-induced movement therap...

Es ist vielleicht gerechtfertigt zu sagen, dass die Befunde der funktionellen Bildgebung der letzten 10 Jahre bei Schlaganfallpatienten viele Gedanken der Rehabilitation auf eine neue neurobiologische Basis gestellt haben und dadurch der Rehabilitation Schwung, Interesse und neuen Enthusiasmus gebracht haben und auch Wege aufgezeigt haben, wie reha...

As in many medical fields, the demand for evidence-based therapies increases also in neurorehabilitation. In post-stroke hemiparesis and aphasia however, there is a significant discrepancy between evidence-based therapies and daily experience. Adding to that, new therapies based on individual patient criteria are currently developed and examined in...

Spasticity manifesting as a dysbalance between extensor and flexor muscles may contribute to an impaired hand function. We studied clinical (n=10 patients) and electrophysiological (n=9 patients) changes produced by vibration of forearm extensor muscles (FEM) in chronic stroke patients with spastic hemiparesis. In Exp. 1, the Box and Block Test (BB...

To explore the effects of motor imagery (MI) and action observation (AO) of foot movements on motor excitability. Fifteen healthy subjects were studied at rest, during MI of foot dorsiflexions and during watching a video of foot dorsiflexions. Transcranial magnetic stimulation was used to explore corticospinal and intracortical excitability by comp...

Knowledge about evidence-based therapeutic approaches becomes increasingly important not only in acute medicine, but also in rehabilitation. This paper reviews several interventions for motor rehabilitation of upper and lower extremity paresis after stroke. Papers published in recent years (2008 and 2009) are preferentially considered. The main foc...

We tested whether the silent period, an indicator of inhibitory neuronal activity, is modulated by muscle vibration. Vibration was applied to the right extensor carpi radialis (ECR) muscle in 17 healthy subjects and, as a control experiment, to the dorsal terminal phalanges in 5 subjects. Data before vibration were compared with those during vibrat...

To investigate the effects of Modafinil on focused attention, motor function and motor excitability in patients with multiple sclerosis (MS) and fatigue. 21 MS patients with fatigue were enrolled in this double-blind placebo-controlled study. Modafinil (MOD) or placebo (PL) was administered for 8 weeks. The d2 alertness test, the Nine Hole Peg Test...

The permanent vegetative state represents one of the most severe brain dysfunctions. Depending on its cause, 15-90% of the patients develop a partial recovery over time. However, a considerable number of patients will not reach an advanced remission state. Since 2000, 4 patients have been reported who unexpectedly showed transient arousal after ing...

Background Patients with motor conversion disorders present an inability to execute movements voluntarily, although central and peripheral motor pathways are normal. We speculated that this phenomenon could be due to an abnormal loss of excitatory drive on central motor areas. Methods The effect of motor imagery on motor excitability was tested in...

To evaluate current evidence that recovery after stroke or traumatic brain injury (TBI) can be enhanced by drugs that modulate neurotransmission in the brain. Small studies performed in chronic stroke patients have indicated that single doses of reboxetine or citalopram improved different aspects of motor functions and that long-lasting application...

Several studies showed that Constraint-Induced Movement Therapy (CIMT) leads to a lasting improvement of upper extremity function in chronic stroke patients. The original technique includes an intensive 2-week program with 6 hours of daily physiotherapy. Due to high expenses it is difficult to implement this concept in outpatient care. The objectiv...

In patients with a functional (psychogenic) paresis, motor conduction tests are, by definition, normal. We investigated whether these patients exhibit an abnormal motor excitability. Four female patients with a functional paresis of the left upper extremity were studied using transcranial magnetic stimulation (TMS). We investigated motor thresholds...

Sowohl rTMS als auch tDCS finden zunehmend Anwendung in der neurorehabilatorischen Therapie des Schlaganfalls. Im Rahmen dieses Vortrages werden aktuelle Studienergebnisse und Sicherheitsaspekte der Verfahren bei Patienten mit Schlaganfall und in der Rehabilitation dargestellt.

A majority of stroke patients have persisting motor deficits despite ongoing physiotherapy. Therefore, additional treatment options are desirable. We investigated if the serotonin reuptake inhibitor, citalopram, would improve motor functions in chronic stroke patients. In all, 8 patients >6 months after their stroke participated in a double-blind,...

Introduction: Diffusion Tensor Imaging (DTI) is able to detect damage of subcortical tract systems by measuring changes in fractional anisotropy (FA). Previous studies indicate that the extent of early diffuse axonal injury (DAI) correlates with the severity of the functional neurological deficits following traumatic brain injury. The present study...

To investigate whether the increased urge to move the legs in restless legs syndrome (RLS) corresponds to an electrophysiological phenomenon and whether motor excitability or behavior is influenced by the treatment with a dopamine agonist. We examined 10 patients who had RLS with transcranial magnetic stimulation (TMS) before and during treatment w...

Transcranial magnetic stimulation (TMS) was introduced in 1985 and has become an important tool for the diagnosis of central motor pathway lesions and for the exploration of motor excitability in health and disease. Moreover, it gains an increasing relevance as a therapeutic tool. The current flow in the coil induces a short-lasting magnetic field...