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ZusammenfassungDie überwiegende Anzahl bisheriger Studien zu Apraxien fokussiert die Rolle der linken Hemisphäre (LH), obwohl im klinischen Alltag apraktische Defizite auch bei Patienten mit rechtshemisphärischen Schlaganfällen (RH) beobachtet werden. Daher wurden in der aktuellen Untersuchung die Prävalenz und Ausprägung apraktischer Defizite bei Patienten mit linkshemisphärischen (n = 66) und rechtshemisphärischen (n = 73) Schlaganfällen verglichen, nachdem für Alter und sprachliche Leistung kontrolliert worden war.Unter Anwendung dieser Kontrollvariablen ergab sich kein signifikanter Unterschied zwischen den linkshemisphärisch und rechtshemisphärisch betroffenen Patienten bei der Imitation von Handpositionen. Übereinstimmend mit früheren Berichten schnitten die Patienten mit rechtshemisphärischen Schlaganfällen aber bei der Imitation der Fingerkonstellationen schlechter ab. Interessanterweise zeigten die rechtshemisphärisch betroffenen Patienten auch geringere Leistungen bei den bukkofazialen Items des Kölner Apraxie Screenings (KAS), vornehmlich bei Gesten der oberen Gesichtshälfte. Für beide Patientengruppen wirkten sich sprachliche Auffälligkeiten mehr auf die Pantomime- als auf die Imitationsleistungen beeinträchtigend aus.Die Ergebnisse legen nahe, dass nach der Kontrolle für Alter und sprachliche Leistungen die Prävalenz und Ausprägung apraktischer Defizite bei Patienten mit rechts- und linkshemisphärischen Schlaganfällen nicht signifikant unterschiedlich sind und in den jeweiligen Rehabilitationsprogrammen entsprechend berücksichtigt werden sollten.

Zusammenfassung. Multiple Sklerose (MS) kann bereits in der mittleren Lebensphase (36 bis 55 Jahre) die berufliche Teilhabe entscheidend beeinflussen. Diese Studie untersuchte, inwieweit sich 86 MS-Erkrankte mit unterschiedlicher beruflicher Leistungseinstufung bezüglich ausgewählter Studienvariablen zum Zeitpunkt der Fragebogenerhebung (T1) und der stationären Entlassung (T0) unterschieden. Die Gesamtstichprobe zeigte leichtgradige kognitive Dysfunktionen und ausgeprägte Fatiguewerte. Mittels logistischer Regressionsanalysen prädizierten die Variablen Tonische Alertness (TAP), Motorische Fatigue (FSMC), Expanded Disability Status Scale (EDSS) und Cognitive Reserve Index questionnaire (CRIq; CRI-Arbeit) die Leistungsbeurteilung bei T0 zu 71 %. Den Variablen Krankheitsdauer, Motorische Fatigue, Selbstwirksamkeit (FERUS) und Neuropsychologischer Störungsindex gelang dies zu 67 % bei T1. Die Studienergebnisse zeigen, dass motorische Fatigue und (spezifische und globale) neuropsychologische Marker ein relevantes Erklärungspotenzial hinsichtlich der Erwerbseinstufung von MS-Erkrankten besitzen. Zudem scheint die Selbstwirksamkeit die Erwerbsfähigkeit positiv zu beeinflussen.

Background: Music-assisted treadmill training (MATT) is a new therapeutic approach for Parkinson's disease (PD) patients, combining treadmill training with rhythmic auditory cueing and visual feedback. PD studies have shown larger positive effects on motor outcomes than usual treadmill training. However, effects on cognition, in contrast, are less clear. Existing studies provided intensive training protocols and included only stable medicated patients. Thus, a pilot randomized controlled trial was designed to analyze the feasibility of a shorter training protocol as well as preliminary effects on cognition, motor function, and patient-centered outcomes in a rehabilitation setting where PD patients with and without deep brain stimulation (DBS) undergo adaptation of medication and DBS settings. Here, we present the results from the feasibility analysis of the still ongoing trial. Methods: Non-demented PD patients with and without DBS were recruited during their inpatient rehabilitation and randomized to an experimental group (EG; 20 min MATT) or an active control group (CG; 20 min bike ergometer training). The trainings took place for 8 consecutive days and were added to the usual rehabilitation. Feasibility was assessed with the following parameters: patients' study protocol acceptance, study protocol transferability into clinical routine, training-induced adverse events, and patients' training perception. Results: Thirty-two patients (EG: n = 15; CG: n = 17; 72% DBS) were included. The study protocol was well-accepted (inclusion rate: 84%). It was transferable into clinical routines; dropout rates of 40% (EG) and 18% (CG) were observed. However, an in-depth analysis of the dropout cohort did not reveal intervention-related dropout reasons. The MATT and the standard ergometer training showed no adverse events and were positively perceived by PD patients with and without DBS. Conclusion: MATT was shown to be a feasible, safe, and enjoyable treatment option in PD patients with and without DBS. Furthermore, the dropout cohort analysis revealed some exciting first insights into possible dropout reasons that go beyond the form of intervention. Therefore, research would benefit from a common practice of dropout analyses, as this would enhance our understanding of patients' therapy adherence and expectations.

During neurorehabilitation, the re-learning of motor sequences is crucial for patients with motor deficits, enabling them to master again complex movements. A recent study showed that patients with left hemisphere (LH) stroke exhibited preserved motor sequence learning (as assessed by the serial reaction time (SRT) task) when the timing of the stimuli was comparable in the training and later test phase. However, patients showed significantly smaller learning scores as compared to healthy controls when the temporal delay between the patient's motor response and the following stimulus was randomized in the test phase. We here investigated whether LH stroke patients were able to learn spatial motor sequences even if no predictable temporal information was provided (i.e., adopting random response-stimulus intervals, RSIs) already during the training phase. Twelve right-handed LH stroke patients and 18 right-handed healthy controls performed a SRT task with random RSIs to test incidental learning of a complex spatial motor sequence. Results indicate that, although the learning condition with random RSIs was more difficult than learning with predictable RSIs, LH stroke patients performed as well as healthy controls regarding sequence specific learning. Thus, data show for the first time that LH stroke patients are able to incidentally learn a spatial sequence even when no predictable temporal information is available.

Background To date, specific therapeutic approaches to expedite recovery from apraxic deficits after left hemisphere (LH) stroke remain sparse. Thus, in this pilot study we evaluated the effect of anodal transcranial direct current stimulation (tDCS) in addition to a standardized motor training on apraxic imitation deficits. Methods In a rehabilitation hospital, we assessed apraxic, aphasic, and motor deficits in 30 LH stroke patients before and after a five-day standard programme of motor training combined with either anodal (10 min, 2 mA; n = 14) or sham (10 min, 0 mA, n = 16) tDCS applied in a double-blind fashion over left posterior parietal cortex (PPC). Where appropriate, data were analyzed with either t-test, Fisher’s exact test, or univariate/ repeated measures ANOVA. Results Compared to sham tDCS, five sessions of anodal tDCS expedited recovery from apraxic imitation deficits (p Conclusions Data from this pilot study show that repetitive, anodal tDCS over left PPC combined with a standardized motor training expedites recovery from imitation deficits in LH stroke patients with apraxia (relative to sham stimulation). Results suggest that in patients suffering from apraxic imitation deficits a randomized controlled trial (RCT) is warranted that investigates the effects of tDCS applied over PPC in addition to a standardized motor training.

Objective Fatigue and cognitive deficits are frequent symptoms of multiple sclerosis (MS). However, the exact nature of their co-occurrence is not fully understood. We sought to determine the impact of cognitive and physical fatigue on subjective cognitive deficits in MS patients and healthy controls. Methods Self-reports of fatigue (FSMC), depression (CES-D), cognitive deficits (CFQ), and personality traits (NEO-FFI, ANPS) among 30 MS inpatients and 30 healthy controls were analyzed using hierarchical regression models. The frequency of cognitive mistakes was used as the dependent variable and the extent of cognitive and physical fatigue as the independent variable. Results Cognitive fatigue was the only unique and significant predictor of cognitive mistakes in both groups, explaining 13.3% of additional variance in the MS group after correcting for age, mood, and physical fatigue. Physical fatigue had no significant impact on cognitive mistakes. While age had an impact on cognitive mistakes and depression in healthy controls, this association was not significant in MS patients. Depression was significantly correlated with cognitive mistakes and cognitive fatigue in MS patients. Conclusions The interplay of cognitive fatigue and subjective cognitive impairment can be generalized, with the exception of the variables of age and depression, which were shown to have differing impacts on cognitive mistakes in MS patients and healthy controls, respectively. Cognitive fatigue was linked to cognitive mistakes even after correcting for overlapping items in MS patients only. Future research should further investigate the link between cognitive fatigue and attention lapses in daily life by using various objective assessments.

Das Kolner Apraxie-Screening (KAS) erfasst apraktische Defizite nach linkshemispharischen Schlaganfallen. Ziel dieser Studie ist es, durch Anpassungen des Testmaterials des KAS und psychometrische Analysen ein diagnostisches Verfahren fur Patienten mit rechtshemispharischem Schlaganfall zu entwickeln. Mittels Itemanalysen von Daten 77 gesunder Probanden und 100 rechtshemispharischer Schlaganfallpatienten wurden 8 KAS-Items ausgeschlossen. Das somit noch aus 12 Items bestehende KAS-R weist eine gute interne Konsistenz (α = 0,795) sowie eine hohe Sensitivitat (79,4 %) und Spezifitat (84,4 %) auf. Bei einem Cut-off-Wert von ≤ 46 (von 48) Punkten zeigen 39 der 100 Schlaganfallpatienten eine Apraxie. Dabei korreliert das KAS-R – im Sinne einer guten Konstruktvaliditat – signifikant mit den externen Validierungsverfahren. Die Ergebnisse zeigen, dass das KAS-R ein reliables und valides diagnostisches Verfahren fur apraktische Defizite nach rechtshemispharischem Schlaganfall ist.

Background and objective Apraxia is a deficit of motor cognition leading to difficulties in actual tool use, imitation of gestures, and pantomiming object use. To date, little data exist regarding the recovery from apraxic deficits after stroke, and no statistical lesion mapping study investigated the neural correlate of recovery from apraxia. Accordingly, we here examined recovery from apraxic deficits, differential associations of apraxia task (imitation vs. pantomime) and effector (bucco-facial vs. limb apraxia) with recovery, and the underlying neural correlates. Methods We assessed apraxia in 39 patients with left hemisphere (LH) stroke both at admission and approximately 11 days later. Furthermore, we collected clinical imaging data to identify brain regions associated with recovery from apraxic deficits using voxel-based lesion-symptom mapping (VLSM). Results Between the two assessments, a significant recovery from apraxic deficits was observed with a tendency of enhanced recovery of limb compared to bucco-facial apraxia. VLSM analyses revealed that within the lesion pattern initially associated with apraxia, lesions of the left insula were associated with remission of apraxic deficits, whereas lesions to the (inferior) parietal lobe (IPL; supramarginal and angular gyrus) and the superior longitudinal fasciculus (SLF) were associated with persistent apraxic deficits. Conclusions Data suggest that lesions affecting the core regions (and white matter) of the fronto-parietal praxis network cause more persistent apraxic deficits than lesions affecting other regions (here: the left insula) that also contribute to motor cognition and apraxic deficits.

Objective It remains an unresolved research objective to clarify the overlap/association between fatigue (especially its cognitive facet) and depression in People with MS (PwMS). Therefore, in this study the patterns of personality and primary emotional traits (PETs) associated with each (motoric/cognitive fatigue and depression in PwMS) were investigated and compared in order to disentangle the three constructs in PwMS. Additionally, differences in personality and PETs between PwMS and healthy controls (HC) were examined. Method Associations between motoric/cognitive fatigue, depression, personality and PETs were investigated in 52 PwMS. Personality and PETs were also assessed in a gender matched HC sample (N = 52) and results regarding these were compared between PwMS and HC. Results Low extraversion was the only significant predictor of MS related motoric fatigue (β = -.341, p = .013). High neuroticism was a predictor of both MS related cognitive fatigue (β = .426, p = .002) and depression (β = .443, p < .001). Whereas neuroticism was the only significant predictor for MS related cognitive fatigue, the cluster of (high) neuroticism, (high) SADNESS (β = .273, p = .023), and (low) extraversion (β = -.237, p = .025) predicted MS related depression. PwMS showed significantly higher scores in neuroticism and FEAR compared to HC. Conclusions MS related motoric/cognitive fatigue and depression in PwMS share variance. But the substantial amount of non-shared variance (motoric fatigue, depression: 72%; cognitive fatigue, depression: 66%) together with additional predictors for depression (SADNESS being a predictor of depression only), indicate that MS related motoric/cognitive fatigue and depression are distinguishable. Consequently, we recommend assessing especially SADNESS scores to distinguish between MS related fatigue and depression.

Background and Purpose— The present study investigated the lesion anatomy of anosognosia for visuospatial neglect resulting from right hemispheric stroke. Methods— In 63 patients, self-ratings of performance in paper-and-pencil tests were contrasted with external performance ratings. Lesion analysis was conducted on patient subgroups with different degrees of anosognosia but comparable visuospatial impairment. Results— Independent of the severity of visuospatial neglect per se, damage to the right angular and superior temporal gyrus was associated with higher levels of anosognosia. Conclusions— Using a novel assessment of anosognosia for spatial neglect, the present study relates stroke-induced self-awareness deficits to inferior parietal and superior temporal brain damage.