scholarly journals Post-stroke Rehabilitation of Severe Upper Limb Paresis in Germany – Toward Long-Term Treatment With Brain-Computer Interfaces

2021 ◽  
Vol 12 ◽  
Author(s):  
Cornelius Angerhöfer ◽  
Annalisa Colucci ◽  
Mareike Vermehren ◽  
Volker Hömberg ◽  
Surjo R. Soekadar
Keyword(s):  
Upper Limb ◽  
Hand Function ◽  
Treatment Strategies ◽  
Term Treatment ◽  
Brain Computer Interfaces ◽  
Stroke Patients ◽  
Computer Interfaces ◽  
Long Term Treatment ◽  
Upper Limb Paresis

Severe upper limb paresis can represent an immense burden for stroke survivors. Given the rising prevalence of stroke, restoration of severe upper limb motor impairment remains a major challenge for rehabilitation medicine because effective treatment strategies are lacking. Commonly applied interventions in Germany, such as mirror therapy and impairment-oriented training, are limited in efficacy, demanding for new strategies to be found. By translating brain signals into control commands of external devices, brain-computer interfaces (BCIs) and brain-machine interfaces (BMIs) represent promising, neurotechnology-based alternatives for stroke patients with highly restricted arm and hand function. In this mini-review, we outline perspectives on how BCI-based therapy can be integrated into the different stages of neurorehabilitation in Germany to meet a long-term treatment approach: We found that it is most appropriate to start therapy with BCI-based neurofeedback immediately after early rehabilitation. BCI-driven functional electrical stimulation (FES) and BMI robotic therapy are well suited for subsequent post hospital curative treatment in the subacute stage. BCI-based hand exoskeleton training can be continued within outpatient occupational therapy to further improve hand function and address motivational issues in chronic stroke patients. Once the rehabilitation potential is exhausted, BCI technology can be used to drive assistive devices to compensate for impaired function. However, there are several challenges yet to overcome before such long-term treatment strategies can be implemented within broad clinical application: 1. developing reliable BCI systems with better usability; 2. conducting more research to improve BCI training paradigms and 3. establishing reliable methods to identify suitable patients.

scholarly journals The Antisuicidal and Mortality-Reducing Effect of Lithium Prophylaxis: Consequences for Guidelines in Clinical Psychiatry

2003 ◽  
Vol 48 (7) ◽  
pp. 433-439 ◽  
Author(s):  
Bruno Müller-Oerlinghausen ◽  
Anne Berghöfer ◽  
Bernd Ahrens
Keyword(s):  
Affective Disorders ◽  
Excess Mortality ◽  
Treatment Strategies ◽  
Term Treatment ◽  
Prophylactic Efficacy ◽  
Long Term Treatment ◽  
Prescription Rates ◽  
Related Mortality ◽  
Overall Mortality

The suicide-related mortality among patients with affective disorders is approximately 30 times higher, and overall mortality 2 to 3 times higher, than suicide-related mortality in the general population. Lithium has demonstrated possibly specific antisuicidal effects apart from its prophylactic efficacy: it significantly reduces the high excess mortality of patients with affective disorders. To date, suicide-prevention effects have not been shown for antidepressant or anticonvulsant long-term treatment. Clozapine appears to reduce the suicide rate in schizophrenia patients. Against this background, guidelines and algorithms for selecting an appropriate prophylactic strategy for affective disorders should consider the presence of suicidality in patient history. Appropriate lithium prophylaxis prevents approximately 250 suicides yearly in Germany, although lithium salts are infrequently prescribed within the National Health Scheme (specifically, to 0.06% of the population). Rational treatment strategies most likely would demand that prescription rates be about 10 times higher.

scholarly journals Five-Year, Disease-Free Survival after Repeat Palliative Multimodality Therapy in a Patient with Recurrent Metastastic Bladder Cancer

2007 ◽  
Vol 7 ◽  
pp. 1736-1742
Author(s):  
Sebastian Fetscher ◽  
Jan Schmielau ◽  
Wolfgang Schulze-Seemann
Keyword(s):  
Bladder Cancer ◽  
Treatment Strategies ◽  
Disease Free Survival ◽  
Term Treatment ◽  
Short Term ◽  
Course Of Disease ◽  
Free Survival ◽  
Long Term Treatment ◽  
Disease Free

In appropriately selected cases, palliative therapeutic strategies can be adapted to those special features of cancer biographies that indicate an atypical course of disease. Elucidating these features, and adapting multimodal treatment strategies to them, can lead to significantly superior effects when compared to the routine application of conventional treatment algorhythms. A case of regionally metastactic bladder cancer is presented that documents the value of repeat debulking-surgery and repeat radiotherapy leading to unexpected short-term and long-term treatment results.

Long-Term Treatment of Patients with Recurrent Unipolar Major Depression: Evidence to Clinical Practice

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S15) ◽  
pp. 4-5 ◽  
Author(s):  
Martin B. Keller
Keyword(s):  
Treatment Strategies ◽  
Patient Characteristics ◽  
Evidence Base ◽  
Term Treatment ◽  
Recurrent Depression ◽  
Long Term Treatment ◽  
Risk Factors For Recurrence ◽  
The Individual ◽  
Term Management

Major depressive disorder (MDD) is almost exclusively recurrent. The vast majority of patients who experience one episode of MDD will eventually experience at least one more episode during their lifetime. The recurrent nature of MDD increases the burden to both the individual and society. Hence, it is imperative that treatment strategies focus on achieving remission acutely, as well as maintaining of remission and preventing recurrence. The articles in this supplement are based on presentations and a dialogue among a group of experts who convened for a roundtable discussion on improving long-term outcomes with antidepressant therapy.Improving long-term treatment of MDD begins with understanding the clinical course of recurrent depression and the ability to recognize those patients who are at greatest risk for recurrence. James H. Kocsis, MD, reviews the course of recurrent depression, emphasizing the tendency for it to progressively worsen. He also discusses patient characteristics and other risk factors for recurrence as well as current recommendations for long-term management of recurrent depression.Although long-term antidepressant maintenance treatment studies are somewhat limited in number, they provide the evidence base that shapes existing guidelines for long-term management of recurrent depression. Michael E. Thase, MD, examines this evidence for the different classes of antidepressants. In addition, Thase reviews evidence for the efficacy of psychotherapy and discusses its potentially important role in long-term depression management.

Stabilization in the treatment of mania, depression and mixed states

2000 ◽  
Vol 12 (3) ◽  
pp. 110-114 ◽  
Author(s):  
D.J. Kupfer ◽  
E. Frank ◽  
V.J. Grochocinski ◽  
J.F. Luther ◽  
P.R. Houck ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Acute Phase ◽  
Treatment Strategies ◽  
Manic Episode ◽  
Term Treatment ◽  
Therapeutic Approaches ◽  
Mixed States ◽  
Long Term Treatment ◽  
Time To Stabilization

ABSTRACTWhile one major need for improved therapeutic approaches in bipolar disease is the development of long-term treatment strategies, a systematic approach during the acute phase of bipolar disorder is also required. In our own studies we have arbitrarily divided the initial treatment of subjects by the predominant polarity for which they are treated acutely: manic, depressed, or mixed/cycling.1 In this larger investigation of over 150 patients with bipolar disorder, we now demonstrated again that the time to initial stabilization is generally the shortest with a manic episode and the longest with a mixed/cycling episode with the depressed episode in the middle (although almost as long as the mixed/cycling episode). These findings indicate the difficulty of treating both the depressed phase and mixed/cycling episodes in bipolar disorder. It is also noteworthy that gender does not have a significant effect on time to stabilization. Such findings in the acute phase have profound implications in designing and carrying out long-term therapeutic strategies for this disorder.

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