Stroke: electricity and magnets mobile again

After a stroke müshot some patients to Walk or learn to Talk again. Methods such as the magnetic or current stimulation köthe brain can unterstüsupport

Für Hand and brain: The Rüfeedback on the screen improves the learning success

Schlaganfäll create in the brain a lot of confusion. Nerve cells die. Some intact remaining regions reduce their Aktivität, other drive high, rekindle a kind of Störfeuer. The Reason For This Is Zerstörtes tissue sends no stimulatory or inhibitory pulses. Dead cells don’t grow back.

However, the network in which you were active, you can reorganize. Other areas üaccept in the Wake of their tasks. The erklärt, wa­rum it will create many patients, after a stroke speak again, or go to learn. However, only the least vollst&auml recover;fully. After three months of recovery, 60 per cent approximately, with a slight and about 30 percent with a moderate to severe disability.

Magnetic and direct current stimulation to improve the success of learning

Doctors researching Ways to improve Rehabilitation. Now you have achieved success with two technical procedures of außen act directly on the brain: transcranial magnetic stimulation and transcranial direct current stimulation. With both methods, certain areas can enable or inhibit.

"So we, the network architecture of the brain try to the Healthy way to modulieren", erklärt Professor Gereon Fink, PräPresident of the German society für neurology and ämedical Director of the Neuro­logical Department of the Universitäclinic Köln. There both stimulation will be explored method. So Finks employees are treated on one side of the geläfamous stroke patients üabout three weeks ein­time täwith the magnetic method. Anschließend completed patients an intensive hand training – and thus achieved better Lern­success, as study participants, whose brain had been sham stimulated.

Achievements researchers to Fink with the DC method – in patients in whom areas of the Brain had failed, the learned Bewegungsabläufe tax: about tying shoes, Zäteeth brushing, using a knife and fork to eat. Also get the treated Pa­tients stägreater improvements than the comparison group. Follow-up studies with a größeren and the number of participants is already underway. Fink expects that by the end of 2019 with the results. Then, it will become clear what the two stimulation techniques for the long term. 

Treatment with magnetic fields or current: No Standard therapy

Physicians Fink speaks dafür, the brain of stroke patients to treat initially only in the context of scientific investigations with magnetic fields or electricity. So give it to the medical guidelines – also because of the risk, the recovery beeinträmighty, if you make a mistake. Fink: "It is not even standard therapies that should be broadly applied." 

The effects of both methods to überprüfen, scientists use the functional Magnetresonanz­imaging (fMRI). The imaging method verrät if the Aktivitätsmuster in the brain verächange – and if that brings an improvement. In the previously mentioned study, on one side of the geläfamous patients managed with transcranial magnetic stimulation, the Störfeuer from the healthy Hirnhähalf to bäcomplete. The hand training of the Affected and made more effective.

The transcranial magnetic stimulation causes:

Improved Übungserfolg

Immediately after the Stimulation the patient is trained to grab a glass. The brain is now für Learning empfämore accessible.

The effect on the brain

The fMRI images show what the effect of targeted inhibition in stroke patients. The Störfeuer from the healthy right Hirnhähalf was unterdrückt (circuit).

Unclear who is, from what Hirnverächanges to benefits

However, researchers know längst is not always what Hirnverächanges für the patients are really good. This shows, for example, an observation of Professor Ariel Schoenfeld, ämedical Director of the Schmieder clinics in Heidelberg. He examined the brain of individuals, their Fuß could not lift and therefore, a bumpy course. A Problem of 10 to 20 percent of people after a stroke. 

Schoenfeld wämissed füin his study, patients with an implanted Fußbrace back to normal could go. This is activated by means of electrical signals the Fußlifter muscle. After three months of Training, the researchers switched the power on and experienced a Üsurprise. Wäwhile some patients continued to be normal, fell soon to the other in a bumpy course zurück. But why? 

Revealing the ver&auml were;modified Aktivitätsmuster in the brain. In the patients, the old response pattern zurückgefallen were steered in the meantime, the healthy Hirnhäthe &shy half;Movement. In the case of those with a flüone of gait, however, had a ­The area at the location of the Zerstöthe command üaccepted. "Für the Fußhighlighting this apparently is the more sustainable Reorganisation", Schoenfeld commented on the results, he künewly in the journal Scien­tific Reports veröpublished.

No reimbursement by health insurance companies

This suspicion should erhägardens, to use of the neurologist is transcranial direct current stimulation, in order to draw the tag in the corresponding direction – so the geschädamaged region of the brain activate and healthy inhibit. If this works, köcould patients küin the future, for a time, with gear, robots, or außen fortified stimulating orthoses train – until the brain has re-learned a flüone response to taxes.

The Problem: Currently, statutory health insurance companies reimburse, as a rule, performance in Fußheberschwäche only simpler prostheses: those that fix the ankle, or those that have a spring and so the Fuß a certain amount of leeway. Active prostheses have to pay for the funds so far only in well begrüwere Einzelfäcases. The erklärt also, why the only manufacturer of an implantable brace that has set the sales Recently. Currently, it is uncertain whether or not an other company to fill in. Schoenfeld regrets: "Für me is that the people with an active prosthesis less frequently stüshorten."

At the same time, räa umt that the products are expensive and größEUA is a lack of studies that prove their advantage. The f&uuml is, however,;r many ­other innovations in the Rehabili­ta­tion. Although systematic &Uuml show;review work of technical Geräte für is the Arm and leg training of the patient nüsupport. But what are the products benefits and how long and intensively you dafür has to work with them, is hardly explored and compared with each other. It is also not clear whether an expensive training to bring robots more than simpler electro-mechanical AIDS.

Rehabilitation: The will zählt, the technology unterstüsupports only

Anyway the technology used &uuml decides;about the success of the Rehabilitation. Crucial to this is a fr&uuml are rather;hzeitiger the beginning, a high Intensität and a on Each of the matched Mix of modules, such as occupational and physiotherapy, speech, swallowing and movement training as well as psycho-therapeutic help.

"The most Important thing is the Motivation of the patient to trainieren", erklärt physician Fink. Brain stimulators ma­cells nerve cells empfämore accessible fürs Learning, course of robot relieve the Köbody and unterstüto support the movements. However, the patients müshot a Pro-active and always at their performance limits are going to möas many lost Fäskills re-acquire. The technique only works unterstützend.

Age plays für the rehabilitation success of any role

The rehab-success hängt außalso, not from age . So a &shy revealed;Study with nearly 2300 participants at the St. Mauritius therapy clinic in Meerbusch: in stroke patients, the über 80, benefit just as much of a vierwöspeaking inten­si­ven Neuro-Rehabilitation as Affected under the age of 65. The results were 2015 in the scientific journal Journal of Neurology, Neurosurgery and ­Psychiatry veröpublished.

Fink äit upset, if health insurance äolder people do not approve of Rehabilitation, because this will bring you supposedly nothing more. "We have a good Rehabilitation system in Germany. Äolder patients may not refuse the Chance to benefit from it." A guarantee of success, there is never. It happens again and again, that people after a stroke pflegebedüin need of renovation. However, in principle, behält the brain into old age, his Fäability to re-organise itself. And new techniques köcould help him in this.

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