R. Falland’s scientific contributions

Objective: Can stimulation of nerve growth factors by focused transcranial extracorporeal shock wave therapy (TESWT) be made effective for persons within unresponsive wakefulness syndrome (apallic syndrome)? Design: Between eight and 18 years after the brain lesion, five patients with unresponsive wakefulness syndrome of differing severity received TESWT with the device Duolith (Storz Medical) during four-week physicomedical complex therapies. In the previous years they had been treated with the same complex therapies without TESWT. The vigilance did not change. Results: After two-four years and an average of 5.2 treatment series, the patients' abilities improved by 135.9% on the German Coma Remission Scale (KRS) and by 43.6% on the Glasgow Coma Scale. In the motor area of the KRS, the patients improved by 64.3%. Three PEG feeding tubes could be removed, nonverbal communication initiated four times. Conclusion: In this longitudinal observation study, focused TESWT stimulated vigilance in patients with unresponsive wakefulness syndrome. The precise neurophysiological effects remain to be verified by a study of the clinical results.

Fragestellung: Kann die Stimulierung von Nervenwachstumsfaktoren durch fokussierte transkranielle extrakorporale Stoßwellen (TESW) für Menschen im Wachkoma nutzbar gemacht werden? Patienten und Methode: Fünf Patienten, die sich seit 7–17 Jahren im Wachkoma verschiedener Schweregrade befanden, erhielten im Verlauf von 2–4 Jahren durchschnittlich 4,4 Behandlungsserien mit einer physikalisch-medizinischen Komplexbehandlung von je 4 Wochen Dauer. Dabei kamen niedrigenergetische fokussierte extrakorporale Stoßwellen (Gerät Duolith, Storz Medical) auf die spastisch veränderte Muskulatur zum Einsatz. Eine Verbesserung der Vigilanz hat sich dadurch nicht ergeben. Danach wurden bei denselben Patienten über 2–4 Jahre durchschnittlich 5,2 dieser 4-wöchigen Komplexbehandlungen mit zusätzlichen TESW durchgeführt. Vor und nach den Behandlungsserien wurden Messungen mit der Komaremissionsskala (KRS) und der Skala Expressive Kommunikation und Selbstaktualisierung (SEKS) durchgeführt. Ergebnisse: Die Patienten verbesserten ihre Fähigkeiten um 135,9% auf der KRS und um 81,7% im SEKS-Test. Drei PEG-Sonden konnten entfernt, 4–mal die nonverbale Kommunikation angebahnt werden. Diskussion: Mögliche Wirkmechanismen und Beziehungen zu anderen nicht invasiven Methoden der Hirnstimulationen werden diskutiert. Schlussfolgerung: TESW scheinen die Vigilanz und Motorik bei Patienten im Wachkoma zu verbessern. Ein etwaiger Placeboeffekt und die neurophysiologischen Effekte müssen überprüft werden.

In a prospective randomised trial with a historical control group, 54 children with cerebral palsy were classified after Palisano and assessed with Russell's Gross Motor Function Measure (GMFM). All patients were older than the age at which children can be expected to have reached 90% of their final gross motor development according to Rosenbaum. The children underwent a complex therapy consisting in special techniques of manual medicine suitable for children and physiotherapy; after 10 treatment sessions within 2 weeks a second GMFM assessment was carried out. In 36 cases the patients had to be excluded from further participation in the trial, for prospectively defined reasons. A drop out analysis is broadly discussed. After 7 months the remaining 18 children, who had continued with their physiotherapy at home, were assessed for a third time with the GMFM. A second course of the complex therapy was then administered, after which they were assessed with the GMFM for a fourth time. Results: The 54 children improved by 2.95 points (on the GMFM) or by 6.8% in their gross motor abilities during the first 2-week complex therapy. During the 7-month subsequent observation period the 18 remaining patients' former results were augmented by a further gain of 1.31 points or 3.13%. There was a long-term improvement by 3.4 points or 10.44% after the total study period of 7.5 months. After a second 2-week course of complex therapy the overall improvement in gross motor abilities was 5.71 points or 17.55%. This study provides strong evidence showing that the complex therapy described can be effective in fostering the gross motor abilities of children with cerebral palsy.

The “complex therapy” of children affected by motor disturbances includes various techniques of muskulo-sceletal medicine following the guidelines of the Deutsche Gesellschaft für Manuelle Medizin combined with different physiotherapeutical treatment techniques. Goal of the treatment is the decrease of reversible dysfunctions of muscles and joints to improve motor function and in consequence the decrease of motor developmental delay. In order to evaluate this conception 80 children affected by cerebral palsy (m/f=1,7; average of age=5,8 yrs) were assessed by the “Gross Motor Function Measure” (GMFM) before and after a 2 week daily treatment. The children showed a remarkable gain of gross motor function within these two weeks.