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Boltzmann M, Schmidt SB, Gutenbrunner C, Krauss JK, Höglinger GU, Weimar C, Rollnik JD. Validity of the Early Functional Ability scale (EFA) among critically ill patients undergoing early neurological rehabilitation. BMC Neurol 2022; 22:333. [PMID: 36068496 PMCID: PMC9446867 DOI: 10.1186/s12883-022-02855-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background A reliable assessment of the functional abilities of patients after severe brain damage is crucial for valid prognostication and treatment decisions, but most clinical scales are of limited use among this specific group of patients. Aim The present study investigates the usefulness of the Early Functional Ability (EFA) scale, which determines the functional abilities of severely impaired patients. Methods Critically ill patients consecutively admitted to early neurological rehabilitation were screened for eligibility. We assessed the correlation between the EFA scale and (i) the Early Rehabilitation Barthel Index (ERBI), and (ii) the Coma Recovery Scale-Revised (CRS-R). The 1-year outcome on the Glasgow Outcome Scale-extended (GOSE) was used to examine the predictive validity. Demographical and medical variables were entered into univariate and multivariate binary regression models to identify independent predictors of 1-year outcome. Results Two hundred fifty-seven patients (168 men) with a median age of 62 years (IQR = 51–75) were enrolled. The correlation of the EFA scale with the CRS-R was high but low with the ERBI upon admission. Multivariate regression analysis yielded the vegetative subscale of the EFA scale as the only independent predictor for the 1-year outcome of patients admitted to early neurological rehabilitation. Conclusions This study shows a high correlation of the EFA scale with the CRS-R but a weak correlation with the ERBI in patients with low functional abilities. With improving patient abilities, these correlations were partly reversed. Thus, the EFA scale is a useful tool to assess the functional abilities and the prognosis of critically ill patients adequately and may be more feasible than other scales.
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Affiliation(s)
- Melanie Boltzmann
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany.
| | - Simone B Schmidt
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | | | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | | | - Christian Weimar
- Institute for Medical Informatics, Biometry and Epidemiology, University of Duisburg-Essen, Essen, Germany.,BDH-Clinic Elzach, Elzach, Germany
| | - Jens D Rollnik
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
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Schmidt SB, Boltzmann M, Rollnik JD. The predictive validity of the Hessisch Oldendorf Risk of Falling Scale (HOSS) decreases during the course of rehabilitation. NeuroRehabilitation 2022; 50:485-491. [DOI: 10.3233/nre-210228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Falls are highly frequent among neurological patients during rehabilitation and subsequent risk assessments are crucial to prevent falls. OBJECTIVE: This study aims to determine the predictive values of the Hessisch Oldendorf Risk of Falling Scale (HOSS, “Hessisch Oldendorfer Sturzrisiko Skala”) for two timeframes: the first month of rehabilitation and from the second month to the end of rehabilitation. METHODS: Scale performances were assessed for 512 patients during inpatient neurological rehabilitation by calculating the sensitivity and the specificity. HOSS items were entered into a binary logistic regression model. Fall rates were calculated and used for correlation analyses and group comparisons. RESULTS: Initial HOSS assessment showed a sensitivity of 80.4% and a specificity of 60.7%. The HOSS re-assessment resulted in a sensitivity of 67.3% and a specificity of 69.5%. Only a non-somnolent state was identified to increase the risk of falling in both timeframes. Patients with a moderate impaired functional status (Barthel-Index between 20 and 50 points) showed the highest fall rates. CONCLUSION: The predictive validity of the HOSS decreases during the rehabilitation course. This might be caused by an altered relevance of the HOSS items during the re-assessment compared to the initial assessment for which the HOSS was developed for.
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Boltzmann M, Schmidt SB, Gutenbrunner C, Krauss JK, Höglinger GU, Rollnik JD. One-year outcome of brain injured patients undergoing early neurological rehabilitation: a prospective observational study. BMC Neurol 2022; 22:30. [PMID: 35039012 PMCID: PMC8762846 DOI: 10.1186/s12883-022-02549-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background The present study intended to analyze the outcome of patients with severe brain injury one-year after discharge from early rehabilitation. Methods Early neurological rehabilitation patients admitted to intensive or intermediate care units and discharged between June 2018 and May 2020 were screened for eligibility. The level of consciousness was evaluated using the Coma Recovery Scale-Revised (CRS-R) upon admission and at discharge. At one-year follow-up, the outcome was assessed with the Glasgow Outcome Scale-extended (GOSE). Demographical and clinical data collected during inpatient rehabilitation were used to predict the outcome 1 year after discharge. Results Two hundred sixty-four patients (174 males, 90 females) with a median age of 62 years (IQR = 51–75) and a median duration of their disease of 18 days (IQR = 12–28) were included in the study. At follow-up, the mortality rate was 27% (n = 71). Age and discharge CRS-R total score were independent predictors in a Cox proportional hazards model with death (yes/no) as the dependent variable. According to the GOSE interviews, most patients were either dead (n = 71; 27%), in a vegetative state (n = 28; 11%) or had a severe disability (n = 124; 47%), whereas only a few patients showed a moderate disability (n = 18; 7%) or a good recovery (n = 23; 9%) 1 year after discharge. Age, non-traumatic etiology, discharge CRS-R total score and length of stay independently predicted whether the outcome was good or poor at follow-up. Conclusion Age was an important predictor for outcome at one-year follow-up, which might be due to altered brain plasticity and more comorbidities in elderly subjects. In addition, the present study demonstrated that the CRS-R total score at discharge might be more important for the prediction of one-year outcome than the initial assessment upon admission.
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Affiliation(s)
- Melanie Boltzmann
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany.
| | - Simone B Schmidt
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | | | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | | | - Jens D Rollnik
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
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Gottlieb A, Boltzmann M, Schmidt SB, Gutenbrunner C, Krauss JK, Stangel M, Höglinger GU, Wallesch CW, Rollnik JD. Treatment of upper limb spasticity with inhibitory repetitive transcranial magnetic stimulation: A randomized placebo-controlled trial. NeuroRehabilitation 2021; 49:425-434. [PMID: 34542038 DOI: 10.3233/nre-210088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Upper limb dysfunction is a frequent complication after stroke impairing outcome. Inhibitory repetitive transcranial magnetic stimulation (rTMS) applied over the contralesional hemisphere is supposed to enhance the positive effects of conventional rehabilitative treatment. OBJECTIVE This double-blind randomized placebo-controlled trial investigated whether inhibitory rTMS as add-on to standard therapy improves upper limb spasticity. METHODS Twenty-eight patients (aged 44 to 80 years) with unilateral stroke in the middle cerebral artery territory were analyzed. Participants were randomly assigned to inhibitory, low-frequency (LF-) rTMS (n = 14) or sham-rTMS (n = 14). The primary outcome measure was the spasticity grade, which was assessed with the Modified Ashworth Scale (MAS). In addition, the Fugl-Meyer-Assessment (FMA) for the upper extremity (UE) and a resting-state fMRI were performed to measure motor functions and the sensorimotor network, respectively. RESULTS The MAS score was reduced in the LF-rTMS group only, whereas the FMA score improved in both groups over time. Regarding the fMRI data, both groups activated typical regions of the sensorimotor network. In the LF-rTMS group, however, connectivity to the left angular gyrus increased after treatment. CONCLUSION Changes in functional connectivity in patients receiving inhibitory rTMS over the contralesional motor cortex suggest that processes of neuronal plasticity are stimulated.
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Affiliation(s)
- Anna Gottlieb
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research (InFo), Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | - Melanie Boltzmann
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research (InFo), Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | - Simone B Schmidt
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research (InFo), Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | | | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Martin Stangel
- Section of Clinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | | | - Jens D Rollnik
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research (InFo), Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
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Wrede S, Keilhaue M, Schmidt SB, Boltzmann M, Rollnik JD. [Relevance of the Clinical Ethics Committee (CEC) for Clinical Staff of a Specialized Neurological Clinic]. REHABILITATION 2021; 61:43-51. [PMID: 34384118 DOI: 10.1055/a-1521-3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Clinical ethics committees (CECs) have been implemented in German clinics since the 1990s. Besides problems with the integration into clinical routines, CECs result in an enrichment and relief for employees and relatives. Investigating the current status of CECs in specialized neurological clinics is crucial because changes in therapy goals towards palliative care are often requested and the treatment team is sometimes overwhelmed with clarifying the presumed patient's wishes. So far, however, there have been no studies that have examined the work of the CEC and its importance for clinical staff in specialized neurological clinics. METHOD In a single-center, prospective observational study, 161 clinic employees with contact to the patients and 10 members of the CEC were asked about their previous experiences and impressions with and in the CEC. At the same time, 31 patients were retrospectively identified for whom an ethical case consultation was carried out by the CEC in 2019. A qualitative evaluation was carried out for the protocols of the ethical case counseling. RESULTS 56% of the clinic employees and 90% of the CEC members considered the CEC as enrichment for the clinic. Although more than a third of the clinic employees evaluated the CEC as a relief during difficult ethical decisions, the presence of the CEC in particular for relatives and employees is described as insufficient. In the majority, a reduction in the hierarchy by the CEC was confirmed by the members of the CEC (70%), whereas the majority of the clinic employees increasingly denied this (55%). The CEC recommendation was implemented in 94% of the cases. CONCLUSION A central problem in working with and within a CEC is maybe the lack of presence and information for employees. Due to this lack of presence, the CEC is not sufficiently visible in everyday clinical practice.
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Affiliation(s)
- Sieke Wrede
- Institut für neurorehabilitative Forschung (InFo) der BDH-Klinik Hessisch Oldendorf, Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), Hessisch Oldendorf, Deutschland
| | - Miriam Keilhaue
- Institut für neurorehabilitative Forschung (InFo) der BDH-Klinik Hessisch Oldendorf, Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), Hessisch Oldendorf, Deutschland
| | - Simone Bianca Schmidt
- Institut für neurorehabilitative Forschung (InFo) der BDH-Klinik Hessisch Oldendorf, Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), Hessisch Oldendorf, Deutschland
| | - Melanie Boltzmann
- Institut für neurorehabilitative Forschung (InFo) der BDH-Klinik Hessisch Oldendorf, Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), Hessisch Oldendorf, Deutschland
| | - Jens Dieter Rollnik
- Institut für neurorehabilitative Forschung (InFo) der BDH-Klinik Hessisch Oldendorf, Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), Hessisch Oldendorf, Deutschland
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Schmidt SB, Boltzmann M, Rollnik JD. Evaluation of the predictive validity of the Hessisch Oldendorf Risk of Falling Scale (HOSS). Clin Rehabil 2021; 36:133-142. [PMID: 34344203 PMCID: PMC8785296 DOI: 10.1177/02692155211034149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: This study aims to further validate the Hessisch Oldendorf Risk of Falling Scale (HOSS) for neurological rehabilitation patients. Design: The overall scale performance and fall rate was calculated in a retrospective data analysis. Setting: The study was performed in a subacute care facility during inpatient neurological rehabilitation. Subjects: The study population (n = 512) included neurological and neurosurgical patients with heterogeneous levels of disability. Main measures: The HOSS total score and the suspected risk of falling were compared with the number of falls. Characteristics of fallers and non-fallers were compared using non-parametric group comparisons. Overall scale performance was assessed by calculating the area under the receiver operating characteristic curve of the HOSS as well as by calculating the sensitivity and specificity. Results: A total of 82 (16%) patients experienced at least one fall. Fallers were characterized by an older age, a longer length of stay, a more severe impairment in the activities of daily living upon admission, a hemiparesis, an orientation disorder, a need of a walking aid device and an urinary incontinence. The number of falls was associated with the HOSS total score. Sixty-four fallers and two hundred seventy-four non-fallers were correctly categorized leading to a sensitivity of 78.0% and a specificity of 63.7%. The area under the receiver operating characteristic curve of the HOSS was 0.778 ± 0.25 (CI = 0.729–0.828, P < 0.001). Conclusion: The scale performance of the HOSS showed a good sensitivity and an adequate specificity to identify neurological patients who are at high risk of falling during inpatient rehabilitation.
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Affiliation(s)
- Simone B Schmidt
- Institute of Neurorehabilitation Research, Associated Institute of the Hanover Medical School, BDH-Clinic Hessisch Oldendorf, Hessisch Oldendorf, Germany
| | - Melanie Boltzmann
- Institute of Neurorehabilitation Research, Associated Institute of the Hanover Medical School, BDH-Clinic Hessisch Oldendorf, Hessisch Oldendorf, Germany
| | - Jens D Rollnik
- Institute of Neurorehabilitation Research, Associated Institute of the Hanover Medical School, BDH-Clinic Hessisch Oldendorf, Hessisch Oldendorf, Germany
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Boltzmann M, Schmidt SB, Gutenbrunner C, Krauss JK, Stangel M, Höglinger GU, Wallesch CW, Münte TF, Rollnik JD. Auditory Stimulation Modulates Resting-State Functional Connectivity in Unresponsive Wakefulness Syndrome Patients. Front Neurosci 2021; 15:554194. [PMID: 33664643 PMCID: PMC7921457 DOI: 10.3389/fnins.2021.554194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 01/06/2021] [Indexed: 12/23/2022] Open
Abstract
Passive listening to music is associated with several psychological and physical benefits in both, healthy and diseased populations. In this fMRI study, we examined whether preferred music has effects on the functional connectivity within resting-state networks related to consciousness. Thirteen patients in unresponsive wakefulness syndrome (UWS) and 18 healthy controls (HC) were enrolled. Both groups were exposed to different auditory stimulation (scanner noise, preferred music, and aversive auditory stimulation). Functional connectivity was analyzed using a seed-based approach. In HC, no differences were found between the three conditions, indicating that their networks are already working at high level. UWS patients showed impaired functional connectivity within all resting-state networks. In addition, functional connectivity of the auditory network was modulated by preferred music and aversive auditory stimulation. Hence, both conditions have the potential to modulate brain activity of UWS patients.
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Affiliation(s)
| | | | | | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Martin Stangel
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | | | - Thomas F Münte
- Department of Neurology, University of Lübeck, Lübeck, Germany
| | - Jens D Rollnik
- BDH-Klinik Hessisch Oldendorf, Hessisch Oldendorf, Germany
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Boltzmann M, Schmidt SB, Gutenbrunner C, Krauss JK, Stangel M, Höglinger GU, Wallesch CW, Rollnik JD. The influence of the CRS-R score on functional outcome in patients with severe brain injury receiving early rehabilitation. BMC Neurol 2021; 21:44. [PMID: 33514337 PMCID: PMC7847163 DOI: 10.1186/s12883-021-02063-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background The aim of the study was to determine the role of the Coma Recovery Scale-Revised (CRS-R) in the prediction of functional status at the end of neurological early rehabilitative treatment. Methods Patients consecutively admitted to intensive or intermediate care units of a neurological rehabilitation center were enrolled in the study. Consciousness and functional status were assessed with the Coma Recovery Scale-Revised (CRS-R) and the Early Rehabilitation Barthel Index (ERBI), respectively. Both assessments were carried out weekly within the first month and at the end of early rehabilitation. Patient and clinical data were entered into a binary logistic regression model to predict functional status at discharge. Results 327 patients (112 females, 215 males) with a median age of 63 years (IQR = 53–75) and a median disease duration of 18 days (IQR = 12–28) were included. Most patients suffered from stroke (59 %), followed by traumatic brain injury (31 %), and hypoxic ischemic encephalopathy (10 %). Upon admission, 12 % were diagnosed as comatose, 31 % as unresponsive wakefulness syndrome (UWS), 35 % as minimally conscious state (MCS) and 22 % already emerged from MCS (eMCS). Of all patients undergoing complete early rehabilitative treatment (n = 180), 72 % showed improvements in level of consciousness (LOC). In this group, age, initial CRS-R score and gains in CRS-R score after four weeks independently predicted functional outcome at discharge. Conclusions The study confirms the relevance of the CRS-R score for functional outcome prediction. High CRS-R scores and young age facilitate functional improvements and increase the probability to continue treatment in subsequent rehabilitation phases. Moreover, results indicate that recovery might occur over a period of time that extends beyond acute care.
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Affiliation(s)
- Melanie Boltzmann
- Institute for Neurorehabilitative Research, Associated Institute of the Hannover Medical School, BDH-Clinic Hessisch Oldendorf, Hessisch Oldendorf, Germany.
| | - Simone B Schmidt
- Institute for Neurorehabilitative Research, Associated Institute of the Hannover Medical School, BDH-Clinic Hessisch Oldendorf, Hessisch Oldendorf, Germany
| | | | - Joachim K Krauss
- Department of Neurosurgery, Hannover Medical School, Hannover, Germany
| | - Martin Stangel
- Department of Neurology, Section of Clinical Neuroimmunology and Neurochemistry, Hannover Medical School, Hannover, Germany
| | | | | | - Jens D Rollnik
- Institute for Neurorehabilitative Research, Associated Institute of the Hannover Medical School, BDH-Clinic Hessisch Oldendorf, Hessisch Oldendorf, Germany
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Jäger DT, Boltzmann M, Rollnik JD, Rüsseler J. Expected Valence Predicts Choice in a Recurrent Decision Task. Front Neurosci 2020; 14:580970. [PMID: 33324148 PMCID: PMC7725750 DOI: 10.3389/fnins.2020.580970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/20/2020] [Indexed: 11/20/2022] Open
Abstract
There is empirical evidence that expected yet not current affect predicts decisions. However, common research designs in affective decision-making show consistent methodological problems (e.g., conceptualization of different emotion concepts; measuring only emotional valence, but not arousal). We developed a gambling task that systematically varied learning experience, average feedback balance and feedback consistency. In Experiment 1 we studied whether predecisional current affect or expected affect predict recurrent gambling responses. Furthermore, we exploratively examined how affective information is represented on a neuronal level in Experiment 2. Expected and current valence and arousal ratings as well as Blood Oxygen Level Dependent (BOLD) responses were analyzed using a within-subject design. We used a generalized mixed effect model to predict gambling responses with the different affect variables. Results suggest a guiding function of expected valence for decisions. In the anticipation period, we found activity in brain areas previously associated with valence-general processing (e.g., anterior cingulate cortex, nucleus accumbens, thalamus) mostly independent of contextual factors. These findings are discussed in the context of the idea of a valence-general affective work-space, a goal-directed account of emotions, and the hypothesis that current affect might be used to form expectations of future outcomes. In conclusion, expected valence seems to be the best predictor of recurrent decisions in gambling tasks.
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Affiliation(s)
- Daniel T Jäger
- Department of Psychology, Otto-Friedrich University of Bamberg, Bamberg, Germany.,Bamberg Graduate School of Affective and Cognitive Science (BaGrACS), Otto-Friedrich University of Bamberg, Bamberg, Germany
| | - Melanie Boltzmann
- Institute for Neurorehabilitative Research, BDH-Clinic Hessisch Oldendorf, Hessisch Oldendorf, Germany
| | - Jens D Rollnik
- Institute for Neurorehabilitative Research, BDH-Clinic Hessisch Oldendorf, Hessisch Oldendorf, Germany
| | - Jascha Rüsseler
- Department of Psychology, Otto-Friedrich University of Bamberg, Bamberg, Germany.,Bamberg Graduate School of Affective and Cognitive Science (BaGrACS), Otto-Friedrich University of Bamberg, Bamberg, Germany
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Mohammadi B, Münte TF, Cole DM, Sami A, Boltzmann M, Rüsseler J. Changed functional connectivity at rest in functional illiterates after extensive literacy training. Neurol Res Pract 2020; 2:12. [PMID: 33324918 PMCID: PMC7650047 DOI: 10.1186/s42466-020-00058-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 04/22/2020] [Indexed: 12/25/2022] Open
Abstract
Background About 6.2 million adults in Germany cannot read and write properly despite attending school for several years. They are considered to be functional illiterates (FI). Since the ability to read and write is crucial for being employed and socially accepted, we developed a special literacy training to overcome these deficits. Methods In this study, we investigate training-related changes in intrinsic functional connectivity (iFC) at rest in a group of 20 FI and 20 adult normal readers using resting state functional magnetic resonance imaging (rsfMRI). We used independent component analysis (ICA) to define different networks. Results Before training, the between group analysis showed increased iFC in FI in a left-fronto-parietal network (LFPN; anterior insula, medial frontal cortex, lateral and frontal parietal regions) and in the Basal Ganglia network (BGN: thalamus, caudate, putamen, pallidum, amygdala, supplementary motor cortex and cingulate gyrus). Furthermore, the Visual Network-1 (VN1; temporal occipital fusiform gyrus, lateral occipital cortex, occipital pole, lingual gyrus, thalamus) showed decreased iFC in FI. After training the FI group showed reversal of the “hyperconnectivity” in middle frontal gyrus and in the frontal orbital cortex and between supramarginal gyrus and the BGN. Furthermore, functional connectivity increased in FI VN1 (lateral occipital cortex, insular cortex). These changes in connectivity correlated with gains in reading speed and spelling accuracy. Conclusions These findings show that poor reading and writing abilities are associated with abnormalities in iFC in several brain areas subserving cognitive processes important for reading. Intensive literacy training induces changes in the functional connectivity between and within neural networks important for literacy skills.
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Affiliation(s)
- Bahram Mohammadi
- CNS-LAB, International Neuroscience Institute (INI), Hannover, Germany.,Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany
| | - Thomas F Münte
- Department of Neurology, University of Lübeck, Ratzeburger Allee 160, 23562 Lübeck, Germany.,Institute of Psychology II, University of Lübeck, Lübeck, Germany
| | - David M Cole
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich & ETH Zurich, Zurich, Switzerland
| | - Amir Sami
- CNS-LAB, International Neuroscience Institute (INI), Hannover, Germany
| | - Melanie Boltzmann
- Department of Psychology, University of Bamberg, Bamberg, Germany.,Bamberg Graduate School of Cognitive and Affective Sciences (BAGrACS), Bamberg, Germany.,Neurologische Klinik Hessisch Oldendorf, Hessisch Oldendorf, Germany
| | - Jascha Rüsseler
- Department of Psychology, University of Bamberg, Bamberg, Germany.,Bamberg Graduate School of Cognitive and Affective Sciences (BAGrACS), Bamberg, Germany
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Schmidt SB, Grüter L, Boltzmann M, Rollnik JD. Prevalence of serum IgG antibodies against SARS-CoV-2 among clinic staff. PLoS One 2020; 15:e0235417. [PMID: 32584894 PMCID: PMC7316280 DOI: 10.1371/journal.pone.0235417] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/15/2020] [Indexed: 01/12/2023] Open
Abstract
The SARS-CoV-2 pandemic threatens health care providers and society. For planning of treatment capacities, it is of major importance to obtain reliable information on infection and fatality rates of the novel coronavirus. A German community study, the so-called Heinsberg study, found a 5-fold higher infection rate (and thus a remarkably lower fatality rate) than the officially reported cases suggest. We were interested to examine the SARS-CoV-2-IgG antibody status among clinic staff of a large neurological center in Northern Germany. Blood samples and questionnaires (demographic data, medical history) were collected pseudonymously. In total, 406 out of 525 (77.3%) of our employees participated in the study. The infection rate among the staff was as high as 2.7%. Including drop-outs (missing questionnaire but test result available), the infection rate was even higher (2.9%). Only 36% of the positively tested employees did suffer from flu-like symptoms in 2020. None of the nurses-having closest and longest contact to patients-were found to be positive. Despite the fact that the infection rate among clinic staff may not be directly compared to the situation in the surrounding county (due to different testing procedures), one might hypothesize that the infection rate could be more than 30-fold higher than the number of officially reported cases for the county of Hameln-Pyrmont. The high rate of IgG-positive, asymptomatic healthcare workers might help to overcome fears in daily work.
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Affiliation(s)
- Simone B. Schmidt
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, associated institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | | | - Melanie Boltzmann
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, associated institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | - Jens D. Rollnik
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, associated institute of Hannover Medical School, Hessisch Oldendorf, Germany
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Flemmer S, Boltzmann M, Schmidt S, Rollnik JD. [Impact of occupational problems on employment status six months after inpatient neurological rehabilitation]. Fortschr Neurol Psychiatr 2020; 89:29-36. [PMID: 32542621 DOI: 10.1055/a-1149-9151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND By identifying occupational problems, job-related therapies may be included in rehabilitation at an early stage, increasing the return-to-work rate. The aim of the present study was to examine whether occupational problems that were identified were associated with the employment status six months after inpatient rehabilitation. METHODS A total of 122 neurological patients undergoing neurological inpatient rehabilitation at the BDH-Clinic Hessisch Oldendorf were retrospectively analysed using clinical routine data from the database of the clinic. Occupational problems were identified with the help of a self-assessment (Wuerzburg Screening [WS]) and an ICF-compliant medical assessment (d850) at the beginning of neurological rehabilitation. In addition, data about the employment status six months after rehabilitation were collected. RESULTS While the BPL identified in the WS was associated with the employment status at the time of follow-up (r=-0.288; p=.007), there was no relationship between the medical assessment of occupational impairment and the employment status. In binary logistic regression models for predicting the employment status, the duration of the incapacity to work, age, gender and an interdisciplinary assessment at the end of rehabilitation proved to be predictors for the employment status. CONCLUSION Occupational problems are associated with occupational reintegration six months after discharge from neurological inpatient rehabilitation. Since occupational problems are taken into account in the treatment planning, the impact on the return to work rate may be underestimated in the current study.
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Affiliation(s)
| | - Melanie Boltzmann
- Institut für neurorehabilitative Forschung (InFo); Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), BDH-Klinik Hessisch Oldendorf GmbH Neurologisches Zentrum mit Intensivmedizin Stroke Unit und phasenubergreifender Rehabilitation
| | - Simone Schmidt
- Institut für neurorehabilitative Forschung (InFo); Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), BDH-Klinik Hessisch Oldendorf GmbH Neurologisches Zentrum mit Intensivmedizin Stroke Unit und phasenubergreifender Rehabilitation
| | - Jens D Rollnik
- Institut für neurorehabilitative Forschung (InFo); Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), BDH-Klinik Hessisch Oldendorf GmbH Neurologisches Zentrum mit Intensivmedizin Stroke Unit und phasenubergreifender Rehabilitation
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Schmidt SB, Boltzmann M, Rollnik JD. Reply-letter to the editor-nutritional situation of enterally fed patients in neurological early rehabilitation and impact of nutritional status on functional outcome. Clin Nutr 2019; 39:323-324. [PMID: 31672330 DOI: 10.1016/j.clnu.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 10/04/2019] [Indexed: 10/25/2022]
Affiliation(s)
- S B Schmidt
- Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Associated Institute of the Hannover Medical School, Hessisch Oldendorf, Germany.
| | - M Boltzmann
- Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Associated Institute of the Hannover Medical School, Hessisch Oldendorf, Germany.
| | - J D Rollnik
- Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Associated Institute of the Hannover Medical School, Hessisch Oldendorf, Germany.
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Totikov A, Boltzmann M, Schmidt SB, Rollnik JD. Influence of paroxysmal sympathetic hyperactivity (PSH) on the functional outcome of neurological early rehabilitation patients: a case control study. BMC Neurol 2019; 19:162. [PMID: 31315589 PMCID: PMC6636123 DOI: 10.1186/s12883-019-1399-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 07/09/2019] [Indexed: 11/16/2022] Open
Abstract
Background Paroxysmal Sympathetic Hyperactivity (PSH) is a frequently observed condition among critically ill patients on intensive care units. According to different studies, PSH is associated with worse recovery and increased mortality in acute-care facilities. In this monocentric, retrospective case-control study, we investigated whether this association also applies to post-acute neurological early rehabilitation. Methods The study included n = 387 patients, admitted to an intensive care or intermediate care unit within 1 year (2016). Among these, 97 patients showed clinical signs of PSH. For each patient with PSH, a patient without PSH was identified, controlling for age, gender, functional and respiratory status upon admission. However, for 25 patients with PSH, there was no suitable control patient fulfilling all defined matching criteria. Primary outcome was type of discharge, dichotomized into favorable (follow-up rehabilitation) and unfavorable outcome (all others). Secondary outcome measures were functional and respiratory status, number of secondary diagnoses, duration of treatment interruptions and length of stay at discharge. Results About 25% of neurological early rehabilitation patients showed clinical signs of PSH. A young age (OR = 0.94; CI = 0.91–0.97) and less severe PSH symptoms (OR = 0.79; CI = 0.69–0.90) were independent predictors of a favorable outcome. In addition, severity of PSH symptoms was associated with weaning duration, while the occurrence of PSH symptoms alone had no influence on most secondary outcome variables. The treatment on intermediate care units proved to be longer for patients with PSH symptoms, only. Conclusions Patients with PSH represent a large group of neurological early rehabilitation patients. Overall, we did not find PSH-related differences in most of the examined outcome measures. However, severe PSH symptoms seem to be associated with poorer outcome and longer treatment on intermediate care units, in order to prevent possible complications.
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Affiliation(s)
- Alan Totikov
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of the Hannover Medical School, Greitstraße 18-28, 31840, Hessisch Oldendorf, Germany
| | - Melanie Boltzmann
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of the Hannover Medical School, Greitstraße 18-28, 31840, Hessisch Oldendorf, Germany.
| | - Simone B Schmidt
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of the Hannover Medical School, Greitstraße 18-28, 31840, Hessisch Oldendorf, Germany
| | - Jens D Rollnik
- BDH-Clinic Hessisch Oldendorf, Institute for Neurorehabilitation Research, Associated Institute of the Hannover Medical School, Greitstraße 18-28, 31840, Hessisch Oldendorf, Germany
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Schmidt SB, Boltzmann M, Krauss JK, Stangel M, Gutenbrunner C, Rollnik JD. Standardized nutritional supply versus individual nutritional assessment: Impact on weight changes, complications and functional outcome from neurological early rehabilitation. Clin Nutr 2019; 39:1225-1233. [PMID: 31151820 DOI: 10.1016/j.clnu.2019.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/08/2019] [Accepted: 05/10/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND & AIMS Approximately 55% of neurological and neurosurgical early rehabilitation (NNER) patients are in need of enteral nutrition, but long-term nutritional assessment of these critically ill patients is suboptimal. Therefore, this study analyzed the effect of an individual nutritional assessment on weight changes during rehabilitation and impact on complications and functional outcome. METHODS 170 NNER patients on enteral nutrition were enrolled in the study. According to the initial ward, patients were assigned to receive standardized enteral nutrition (n = 107, control group) or an individual nutritional assessment (n = 63, intervention group). Weight changes, complications, assessment of the functional outcome (Early Rehabilitation Index, Barthel Index, Early Rehabilitation Barthel Index) and the length of stay were recorded and compared between groups using non-parametric tests for non-paired samples (Mann-Whitney U test for metric data or the χ2 test for categorical data) or paired samples (Wilcoxon test). In addition, daily energy requirement was calculated and compared with daily intake. Correlation analysis by Spearman was performed to investigate linear relationship between weight changes and the difference of administered and calculated calories in both study groups. RESULTS A weight loss was observed in the control group, whereas the weight of the intervention group remained stable over time. The difference between calculated and administered calories correlated with weight changes in the control group. Regarding complications during rehabilitation, control patients showed more frequently impaired diuresis. In addition, control patients were suffering longer from diarrhea than patients of the intervention group. Both groups improved in functional status to a comparable degree. Relationships between these improvements and weight changes or administered calories could not be found. CONCLUSIONS Individual nutritional assessment had not an additional affect for the improvement of functional outcome or the prevention of complications. However, weight turned out to be more stable and signs of nutritional incompatibilities are less frequent among patients being treated with an individualized nutritional assessment.
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Affiliation(s)
- S B Schmidt
- Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany.
| | - M Boltzmann
- Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | - J K Krauss
- Hannover Medical School, Dept. of Neurosurgery, Germany
| | - M Stangel
- Hannover Medical School, Dept. of Neurology, Germany
| | - C Gutenbrunner
- Hannover Medical School, Dept. of Physical Medicine and Rehabilitation, Germany
| | - J D Rollnik
- Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
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Rüsseler J, Boltzmann M, Grosche M. Funktionaler Analphabetismus in Deutschland – Größenordnung, Ursachen, Interventionen. Zeitschrift für Neuropsychologie 2019. [DOI: 10.1024/1016-264x/a000253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Allein in Deutschland verfügen etwa 7.5 Millionen Erwachsene nicht über ausreichende Lese- und Schreibkompetenzen, um in angemessener Weise am gesellschaftlichen Leben teilhaben zu können. Sie können maximal kurze, einfache Texte sinnentnehmend lesen. Diese Personen werden häufig als funktionale Analphabetinnen und Analphabeten bezeichnet. Die Arbeit gibt einen Überblick zu Größenordnung, Ursachen und Interventionsmöglichkeiten bei funktionalem Analphabetismus. Es wird ein biopsychosoziales Ursachenmodell vorgestellt, das biologische Vulnerabilitätsfaktoren postuliert, die unter ungünstigen psychosozialen Bedingungen zu einer erhöhten Wahrscheinlichkeit für die Entwicklung von Lese- und Schreibproblemen führen. Weiterhin wird auf Unterschiede zwischen und Gemeinsamkeiten von funktionalem Analphabetismus und Lese-Rechtschreib-Störung (LRS) eingegangen. Abschließend werden aktuelle Entwicklungen von Trainingsprogrammen zur Förderung der Lese- und Rechtschreibfähigkeiten von Erwachsenen, häufig im Kontext von Grundbildungsprogrammen, beschrieben.
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Affiliation(s)
- Jascha Rüsseler
- Institut für Psychologie, Otto-Friedrich-Universität Bamberg, Bamberg
| | - Melanie Boltzmann
- Institut für neurorehabilitative Forschung, BDH-Klinik Hessisch-Oldendorf, Hessisch-Oldendorf
| | - Michael Grosche
- School of Education, Institut für Bildungsforschung, Bergische Universität Wuppertal, Wuppertal
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Boltzmann M, Münte T, Mohammadi B, Rüsseler J. Functional and structural neural plasticity effects of literacy acquisition in adulthood. Zeitschrift für Neuropsychologie 2019. [DOI: 10.1024/1016-264x/a000254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Abstract. In Germany, 7.5 Million individuals between 18 and 64 years are considered to be functionally illiterate (Grotlüschen & Riekmann, 2012). Functional illiterates have only rudimentary literacy skills despite attending school for several years. Although they can use written language to a very limited extent, only few functional illiterates attend literacy courses for adults. In addition, most adult literacy courses primarily aim at promoting basic reading and writing skills. Offers specific to workplace literacy are scarce. This review gives an overview of the definition of functional illiteracy. Afterwards, a specific literacy program (AlphaPlus) and its effectiveness will be presented. The reviewed studies indicate that learning to read in adulthood is associated with structural and functional brain changes.
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Affiliation(s)
- Melanie Boltzmann
- Institute for Neurorehabilitation Research, BDH-Clinic Hessisch Oldendorf, Hessisch Oldendorf
| | - Thomas Münte
- Department of Neurology, University of Lübeck, Lübeck
- Institute of Psychology 2, University of Lübeck, Lübeck
| | - Bahram Mohammadi
- Department of Neurology, University of Lübeck, Lübeck
- CNS-LAB, International Neuroscience Institute, (INI), Hannover
| | - Jascha Rüsseler
- Department of Psychology, Otto-Friedrich University of Bamberg, Bamberg
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Schmidt SB, Boltzmann M, Rollnik JD. Nutritional situation of enterally fed patients in neurological early rehabilitation and impact of nutritional status on functional outcome. Clin Nutr 2019; 39:425-432. [PMID: 30799195 DOI: 10.1016/j.clnu.2019.02.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/03/2019] [Accepted: 02/03/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND & AIMS Studies focusing on the nutritional status of neurological and neurosurgical early rehabilitation (NNER) patients are limited. The aim of the current study was to determine the nutritional status of NNER patients upon admission, to observe weight changes and to investigate the influence of nutritional status on complications and outcome. METHODS 109 enterally fed NNER patients were included in this prospective observational study. Weight changes, complications, neurological outcome scores (Early Rehabilitation Index [ERI], Barthel-Index [BI]) and the length of stay (LOS) were recorded. In addition, daily energy requirement was calculated and compared with daily intake to identify under-/optimally- and oversupplied patients. RESULTS A general weight loss was observed in the study group. Weight changes during rehabilitation differed between men and women as well as between under- and oversupplied patients. Nutritional supply during rehabilitation had no influence on the LOS and the change of neurological outcome scores, but significant differences in the frequency of nosocomial infections was observed between under-/optimally- and oversupplied patients. The nutritional status (weight group on admission) had a crucial impact on neurological outcome scores, indicated by lower BI at discharge in normal-compared to underweight patients. In addition, underweight + undersupplied patients showed a significantly lower improvement of the BI than underweight + oversupplied patients. To the contrary, underweight + oversupplied patients had a higher BI improvement than underweight + optimally supplied patients. CONCLUSIONS The nutritional status upon admission in combination with the nutritional supply during rehabilitation appears to have an impact on changes of neurological outcome scores.
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Affiliation(s)
- S B Schmidt
- Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Associated Institute of the Hannover Medical School, Hessisch Oldendorf, Germany.
| | - M Boltzmann
- Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Associated Institute of the Hannover Medical School, Hessisch Oldendorf, Germany.
| | - J D Rollnik
- Institute for Neurorehabilitation Research (InFo), BDH-Clinic Hessisch Oldendorf, Associated Institute of the Hannover Medical School, Hessisch Oldendorf, Germany.
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Schmidt SB, Boltzmann M, Bertram M, Bucka C, Hartwich M, Jöbges M, Ketter G, Leineweber B, Mertl-Rötzer M, Nowak DA, Platz T, Scheidtmann K, Thomas R, Rosen FV, Wallesch CW, Woldag H, Peschel P, Mehrholz J, Pohl M, Rollnik JD. Factors influencing weaning from mechanical ventilation in neurological and neurosurgical early rehabilitation patients. Eur J Phys Rehabil Med 2019. [DOI: 10.23736/s1973-9087.18.05100-6 epub 2018 jun 11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Schmidt SB, Boltzmann M, Rollnik JD. [Effects of Respiratory Muscle Training on the Incidence of Pneumonia in Neurological and Neurosurgical Early Rehabilitation: Results from a Matched-Pair Analysis]. REHABILITATION 2018; 58:260-268. [PMID: 30049001 DOI: 10.1055/a-0642-1457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Most disorders in neurological and neurosurgical early rehabilitation (NNER) are associated with an increased pneumonia risk. Respiratory therapy aims to prevent respiratory complications. However, there are no studies showing an effect of respiratory muscle training on the incidence of pneumonia in NNER. METHOD The study included 81 phase-B-patients receiving respiratory muscle training and 81 control patients. Routine data such as age, sex, diagnoses, and comorbidities, length of stay, information on ventilation and incidence of pneumonia were analyzed retrospectively. RESULTS The development of pneumonia was associated with a longer duration of treatment, a higher number of ventilation hours, the presence of a tracheal canula, and a tendency to lower Early Rehabilitation Barthel-Index on admission. The incidence rate of nosocomial pneumonia was 20% in both study groups. The groups differed significantly in disease severity on admission, duration of treatment, number of dysphagia patients, and in therapy intensities of physio and speech therapy. CONCLUSION A direct correlation between the respiratory muscle training and the incidence of pneumonia in the NNER could not be conclusively demonstrated due to the insufficient comparability of both study groups. Besides the duration of ventilation, the intensity of dysphagia therapy was the strongest factor influencing the pneumonia incidence.
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Affiliation(s)
- Simone Bianca Schmidt
- Institut für neurorehabilitative Forschung (InFo) der BDH-Klinik Hessisch Oldendorf, Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), Hessisch Oldendorf
| | - Melanie Boltzmann
- Institut für neurorehabilitative Forschung (InFo) der BDH-Klinik Hessisch Oldendorf, Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), Hessisch Oldendorf
| | - Jens Dieter Rollnik
- Institut für neurorehabilitative Forschung (InFo) der BDH-Klinik Hessisch Oldendorf, Assoziiertes Institut der Medizinischen Hochschule Hannover (MHH), Hessisch Oldendorf
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Schmidt SB, Boltzmann M, Bertram M, Bucka C, Hartwich M, Jöbges M, Ketter G, Leineweber B, Mertl-Rötzer M, Nowak DA, Platz T, Scheidtmann K, Thomas R, Rosen FV, Wallesch CW, Woldag H, Peschel P, Mehrholz J, Pohl M, Rollnik JD. Factors influencing weaning from mechanical ventilation in neurological and neurosurgical early rehabilitation patients. Eur J Phys Rehabil Med 2018; 54:939-946. [PMID: 29898584 DOI: 10.23736/s1973-9087.18.05100-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Studies analyzing risk factors of weaning failure in neurological and neurosurgical early rehabilitation (NNER) patients are rare. AIM The aim of this study was to identify clinical factors influencing the weaning of NNER patients. DESIGN An observational, retrospective data analysis of a German multicenter study was performed. SETTING German neurological early rehabilitation centers. POPULATION Inpatient ventilated NNER patients (N.=192) were enrolled in the study. METHODS Demographical data, main diagnosis, medical devices, special medical care and assessment instruments of functional abilities, consciousness and independence in activities of daily living were accrued and compared between patients with and without successful weaning. The prognostic power of factors associated with weaning success/failure was analyzed using binary logistic regression. RESULTS In total, 75% of the patients were successfully weaned. Colonization with multi-drug resistant bacteria and the need for dialysis were independent predictors of weaning failure. Successfully weaned patients had a shorter length of stay, better functional outcome, and lower mortality than non-successfully weaned patients. CONCLUSIONS Successfully weaned patients differ from patients with weaning failure in several clinical variables. All these variables are associated with the morbidity of the patient, indicating that the weaning process is strongly influenced by disease burden. CLINICAL REHABILITATION IMPACT Functional abilities, level of consciousness, independence in activities of daily living, colonization with multi-drug resistant bacteria, need for dialysis and disease duration might help to predict the weaning process of NNER.
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Affiliation(s)
- Simone B Schmidt
- Institute for Neurorehabilitation Research (InFo), BDH-Klinik Hessisch Oldendorf, Hannover Medical School, Hannover, Germany -
| | - Melanie Boltzmann
- Institute for Neurorehabilitation Research (InFo), BDH-Klinik Hessisch Oldendorf, Hannover Medical School, Hannover, Germany
| | | | | | | | | | - Guido Ketter
- Neurological Rehabilitation Centre "Godeshöhe", Bonn, Germany
| | | | | | | | | | | | | | | | | | - Hartwig Woldag
- Neurologisches Rehabilitationszentrum Leipzig, Leipzig, Germany
| | - Peter Peschel
- Department of Public Health, University of Dresden, Dresden, Germany
| | | | | | - Jens D Rollnik
- Institute for Neurorehabilitation Research (InFo), BDH-Klinik Hessisch Oldendorf, Hannover Medical School, Hannover, Germany
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Hermann O, Schmidt SB, Boltzmann M, Rollnik JD. Comparison of fall prediction by the Hessisch Oldendorf Fall Risk Scale and the Fall Risk Scale by Huhn in neurological rehabilitation: an observational study. Clin Rehabil 2017; 32:671-678. [DOI: 10.1177/0269215517741666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Objective: To calculate scale performance of the newly developed Hessisch Oldendorf Fall Risk Scale (HOSS) for classifying fallers and non-fallers in comparison with the Risk of Falling Scale by Huhn (FSH), a frequently used assessment tool. Design: A prospective observational trail was conducted. Setting: The study was performed in a large specialized neurological rehabilitation facility. Subjects: The study population ( n = 690) included neurological and neurosurgery patients during neurological rehabilitation with varying levels of disability. Around the half of the study patients were independent and dependent in the activities of daily living (ADL), respectively. Interventions: Fall risk of each patient was assessed by HOSS and FSH within the first seven days after admission. Main measures: Event of fall during rehabilitation was compared with HOSS and FSH scores as well as the according fall risk. Scale performance including sensitivity and specificity was calculated for both scales. Results: A total of 107 (15.5%) patients experienced at least one fall. In general, fallers were characterized by an older age, a prolonged length of stay, and a lower Barthel Index (higher dependence in the ADL) on admission than non-fallers. The verification of fall prediction for both scales showed a sensitivity of 83% and a specificity of 64% for the HOSS scale, and a sensitivity of 98% with a specificity of 12% for the FSH scale, respectively. Conclusion: The HOSS shows an adequate sensitivity, a higher specificity and therefore a better scale performance than the FSH. Thus, the HOSS might be superior to existing assessments.
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Affiliation(s)
- Olena Hermann
- Institute for Neurorehabilitation Research, BDH-Clinik Hessisch Oldendorf gGmbH, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | - Simone B Schmidt
- Institute for Neurorehabilitation Research, BDH-Clinik Hessisch Oldendorf gGmbH, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | - Melanie Boltzmann
- Institute for Neurorehabilitation Research, BDH-Clinik Hessisch Oldendorf gGmbH, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
| | - Jens D Rollnik
- Institute for Neurorehabilitation Research, BDH-Clinik Hessisch Oldendorf gGmbH, Associated Institute of Hannover Medical School, Hessisch Oldendorf, Germany
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Rollnik J, Schmidt S, Allmann J, Boltzmann M. Assessment beruflicher Problemlagen in der Neurorehabilitation. Fortschr Neurol Psychiatr 2016; 84:682-689. [DOI: 10.1055/s-0042-116228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Boltzmann M, Rüsseler J. Training-related changes in early visual processing of functionally illiterate adults: evidence from event-related brain potentials. BMC Neurosci 2013; 14:154. [PMID: 24330622 PMCID: PMC4028813 DOI: 10.1186/1471-2202-14-154] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 12/09/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Event-related brain potentials (ERPs) were used to investigate training-related changes in fast visual word recognition of functionally illiterate adults. Analyses focused on the left-lateralized occipito-temporal N170, which represents the earliest processing of visual word forms. Event-related brain potentials were recorded from 20 functional illiterates receiving intensive literacy training for adults, 10 functional illiterates not participating in the training and 14 regular readers while they read words, pseudowords or viewed symbol strings. Subjects were required to press a button whenever a stimulus was immediately repeated. RESULTS Attending intensive literacy training was associated with improvements in reading and writing skills and with an increase of the word-related N170 amplitude. For untrained functional illiterates and regular readers no changes in literacy skills or N170 amplitude were observed. CONCLUSIONS Results of the present study suggest that the word-related N170 can still be modulated in adulthood as a result of the improvements in literacy skills.
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Affiliation(s)
- Melanie Boltzmann
- Department of Experimental Psychology, University of Bamberg, Markusplatz 3, 96047 Bamberg, Germany
| | - Jascha Rüsseler
- Department of Experimental Psychology, University of Bamberg, Markusplatz 3, 96047 Bamberg, Germany
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