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Mirko Aach

Bio: Mirko Aach is an academic researcher from Ruhr University Bochum. The author has contributed to research in topics: Spinal cord injury & Heterotopic ossification. The author has an hindex of 15, co-authored 45 publications receiving 747 citations.


Papers
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Journal ArticleDOI
TL;DR: HAL exoskeleton training results in improved over-ground walking and leads to the assumption of a beneficial effect on ambulatory mobility, however, evaluation in larger clinical trials is required.

186 citations

Journal ArticleDOI
TL;DR: The findings suggest that robotic-assisted BWSTT with HAL® in SCI patients is capable of inducing cortical plasticity following highly repetitive, active locomotive use of paretic legs and brain areas other than S1 might reflect improvement of walking functions.
Abstract: Background Reorganization in the sensorimotor cortex accompanied by increased excitability and enlarged body representations is a consequence of spinal cord injury (SCI). Robotic-assisted bodyweight supported treadmill training (BWSTT) was hypothesized to induce reorganization and improve walking function.

86 citations

Journal ArticleDOI
TL;DR: Findings suggest not only the feasibility of this new approach but in conclusion, demonstrate the effectiveness of neurologic controlled locomotion training in the long-term management of refractory neuropathic pain.
Abstract: Chronic neuropathic pain (CNP) is a common condition associated with spinal cord injury (SCI) and has been reported to be severe, disabling and often treatment-resistant and therefore remains a clinical challenge for the attending physicians. The treatment usually includes pharmacological and/or nonpharmacological approaches. Body weight supported treadmill training (BWSTT) and locomotion training with driven gait orthosis (DGO) have evolved over the last decades and are now considered to be an established part in the rehabilitation of SCI patients. Conventional locomotion training goes along with improvements of the patients' walking abilities in particular speed and gait pattern. The neurologic controlled hybrid assistive limb (HAL®, Cyberdyne Inc., Ibraki, Japan) exoskeleton, however, is a new tailored approach to support motor functions synchronously to the patient's voluntary drive. This report presents two cases of severe chronic and therapy resistant neuropathic pain due to chronic SCI and demonstrates the beneficial effects of neurologic controlled exoskeletal intervention on pain severity and health-related quality of life (HRQoL). Both of these patients were engaged in a 12 weeks period of daily HAL®-supported locomotion training. In addition to improvements in motor functions and walking abilities, both show significant reduction in pain severity and improvements in all HRQoL domains. Although various causal factors likely contribute to abatement of CNP, the reported results occurred due to a new approach in the rehabilitation of chronic spinal cord injury patients. These findings suggest not only the feasibility of this new approach but in conclusion, demonstrate the effectiveness of neurologic controlled locomotion training in the long-term management of refractory neuropathic pain. Implications for Rehabilitation CNP remains a challenge in the rehabilitation of chronic SCI patients. Locomotion training with the HAL exoskeleton seems to improve CNP in chronic SCI. HAL locomotion training is feasible and safe in the rehabilitation of chronic SCI patients.

67 citations

Journal ArticleDOI
TL;DR: There is no consistent benefit from rehabilitation using an exoskeleton versus a variety of conventional methods in patients with chronic spinal cord injury and later-generation exoskeletons are needed.
Abstract: Study Design Systematic review. Clinical Questions (1) When used as an assistive device, do wearable exoskeletons improve lower extremity function or gait compared with knee-ankle-foot orthoses (KAFOs) in patients with complete or incomplete spinal cord injury? (2) When used as a rehabilitation device, do wearable exoskeletons improve lower extremity function or gait compared with other rehabilitation strategies in patients with complete or incomplete spinal cord injury? (3) When used as an assistive or rehabilitation device, are wearable exoskeletons safe compared with KAFO for assistance or other rehabilitation strategies for rehabilitation in patients with complete or incomplete spinal cord injury? Methods PubMed, Cochrane, and Embase databases and reference lists of key articles were searched from database inception to May 2, 2016, to identify studies evaluating the effectiveness of wearable exoskeletons used as assistive or rehabilitative devices in patients with incomplete or complete spinal cord injury. Results No comparison studies were found evaluating exoskeletons as an assistive device. Nine comparison studies (11 publications) evaluated the use of exoskeletons as a rehabilitative device. The 10-meter walk test velocity and Spinal Cord Independence Measure scores showed no difference in change from baseline among patients undergoing exoskeleton training compared with various comparator therapies. The remaining primary outcome measures of 6-minute walk test distance and Walking Index for Spinal Cord Injury I and II and Functional Independence Measure–Locomotor scores showed mixed results, with some studies indicating no difference in change from baseline between exoskeleton training and comparator therapies, some indicating benefit of exoskeleton over comparator therapies, and some indicating benefit of comparator therapies over exoskeleton. Conclusion There is no data to compare locomotion assistance with exoskeleton versus conventional KAFOs. There is no consistent benefit from rehabilitation using an exoskeleton versus a variety of conventional methods in patients with chronic spinal cord injury. Trials comparing later-generation exoskeletons are needed.

62 citations

Journal ArticleDOI
01 Nov 2012-Spine
TL;DR: Adequate management of potential risk factors could help reduce the overall incidence of HO and outcome in patients with traumatic spinal cord injury.
Abstract: Study design Case-control study. Objective We designed a case-control study to analyze the risk factors associated with the development of heterotopic ossification (HO) in patients with traumatic spinal cord injury. Summary of background data Patients with spinal cord injury have a high risk of developing HO, although the exact etiopathogenesis is still unknown. Several factors are known to be potential risk factors. However, we are not aware of any large clinical studies evaluating the risk factors for HO. Methods Patients who were treated for a traumatic spinal cord injury in our hospital, and who subsequently developed HO, were identified by querying the electronic database at our hospital from 2002 to 2010. One hundred thirty-two patients and 132 controls were included. Our primary outcome measures were the risk of developing HO according to whether the patient had experienced a complete spinal cord lesion according to American Spinal Injury Association Impairment Scale; tetraplegia or paraplegia; cervical, thoracic, or lumbar injury; severe chest trauma; and the time interval between injury and surgery. Secondary risk factors explored were patient age; sex; presence and number of comorbidities; length of hospital and intensive care unit stay; associated traumatic injuries; presence of spasticity, pressure ulcers, deep venous thrombosis, and urinary tract infection; and pulmonary complications, such as pneumonia and necessity of tracheostomy. Results Patients with associated spasticity and thoracic trauma, complete lesion, pneumonia, presence of tracheostomy, and urinary tract infection had a higher risk of developing HO. Conclusion Adequate management of potential risk factors could help reduce the overall incidence of HO and outcome in patients with traumatic spinal cord injury.

60 citations


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Reference EntryDOI
15 Jul 2008
TL;DR: Marmosets are poised to be a central player to advance the core mission of the NINDS, as their brains retain the typical anatomical and functional organization of the primate brain and the species exhibits the breadth of cognitive sophistication that distinguishes primates from other taxonomic groups.
Abstract: The core mission of National Institute of Neurological Disorders and Stroke (NINDS) is twofold. First, NINDS seeks fundamental knowledge about the brain and nervous system. Second, NINDS aims to use that knowledge to reduce the burden of neurological diseases. In support of its mission, NINDS performs and funds basic, translational, and clinical neuroscience research on more than 600 neurological diseases, including genetic diseases (e.g. Huntington’s disease; muscular dystrophy), developmental disorders (e.g. cerebral palsy), neurodegenerative diseases (e.g. Parkinson’s disease; Alzheimer’s disease; multiple sclerosis), metabolic diseases (e.g. Gaucher’s disease), cerebrovascular diseases (e.g. stroke; vascular dementia), trauma (e.g. spinal cord and head injury), convulsive disorders (e.g. epilepsy), infectious diseases (e.g. AIDS dementia) and brain tumors. Common marmosets (Callithrix jacchus) offer unique, powerful advantages to both components of the NINDS mission. In support of the first component, marmosets are particularly well suited for neuroanatomical and functional brain studies, as their brains retain the typical anatomical and functional organization of the primate brain. A major advantage is that the marmoset is a lissencephalic primate, which greatly facilitates the mapping of functional brain areas by neuroimaging techniques, such as fMRI and optical imaging, as well as by electrophysiology, with high spatial resolution. In support of the second component, marmosets are excellent models of neurological disorders. Unlike rodents, marmosets are outbred and every individual is genetically different. Further, the marmoset brain has a gray-to-white matter ratio comparable to humans, which strongly facilitates modeling diseases such as multiple sclerosis and small vessel disease. The species also exhibits the breadth of cognitive sophistication that distinguishes primates from other taxonomic groups. Finally, geneedited marmosets can be generated with an intergeneration time and establishment of transgenic lines 2-3 times faster than other primate species, which makes marmosets be the ideal primate species for the development of genetically engineered lines. For all of the above reasons, marmosets are poised to be a central player to advance the core mission of the NINDS.

672 citations

Journal ArticleDOI
01 Feb 2017
TL;DR: Current lower limb robotic exoskeletons are described, with specific regard to common trends in the field, and a number of emerging technologies could deliver substantial advantages to existing and future exoskeleton designs.
Abstract: Research on robotic exoskeletons has rapidly expanded over the previous decade. Advances in robotic hardware and energy supplies have enabled viable prototypes for human testing. This review paper describes current lower limb robotic exoskeletons, with specific regard to common trends in the field. The preponderance of published literature lacks rigorous quantitative evaluations of exoskeleton performance, making it difficult to determine the disadvantages and drawbacks of many of the devices. We analyzed common approaches in exoskeleton design and the convergence, or lack thereof, with certain technologies. We focused on actuators, sensors, energy sources, materials, and control strategies. One of the largest hurdles to be overcome in exoskeleton research is the user interface and control. More intuitive and flexible user interfaces are needed to increase the success of robotic exoskeletons. In the last section, we discuss promising future solutions to the major hurdles in exoskeleton control. A number of emerging technologies could deliver substantial advantages to existing and future exoskeleton designs. We conclude with a listing of the advantages and disadvantages of the emerging technologies and discuss possible futures for the field.

592 citations

Journal ArticleDOI
TL;DR: The risk of HA-CDI remains greatest for cephalosporins and clindamycin, and their importance as inciting agents should not be minimized, particularly if fluoroquinolone-resistant epidemic strains of C. difficile are absent.
Abstract: Objectives: To update the evidence for associations between antibiotic classes and hospital-acquired Clostridium difficile infection (HA-CDI). Methods: Electronic databases of journal articles, scholarly theses and conference proceedings using subject headings and keywords related to CDI and antibiotic exposure were searched. Observational epidemiological studies measuring associations between antibiotic classes and HA-CDI were eligible for inclusion. Pooled ORs and 95% CIs were calculated using a random effects model. Study factors identified a priori were examined as sources of heterogeneity. The quality of the studies was assessed using the Newcastle-Ottawa Scale. Results: Of 569 citations identified, 13 case-control and 1 cohort study (15 938 patients) were included. The strongest associations were found for third-generation cephalosporins (OR = 3.20, 95% CI = 1.80-5.71; n = 6 studies; I2 = 79.2%), clindamycin (2.86, 2.04-4.02; n = 6; I2 = 28.5%), second-generation cephalosporins (2.23, 1.47-3.37; n = 6; I2 = 48.4%), fourth-generation cephalosporins (2.14, 1.30-3.52; n = 2; I2 = 0.0%), carbapenems (1.84, 1.26-2.68; n = 6; I2 = 0.0%), trimethoprim/sulphonamides (1.78, 1.04-3.05; n = 5; I2 = 70%), fluoroquinolones (1.66, 1.17-2.35; n = 10; I2 = 64%) and penicillin combinations (1.45, 1.05-2.02; n = 6; I2 = 54%). The study population and the timing of measurement of antibiotic exposure were the most common sources of heterogeneity. Study quality scored high for seven studies, moderate for six studies and low for one study. Conclusions: The risk of HA-CDI remains greatest for cephalosporins and clindamycin, and their importance as inciting agents should not be minimized. The importance of fluoroquinolones should not be overemphasized, particularly if fluoroquinolone-resistant epidemic strains of C. difficile are absent.

448 citations