[Expectations of stroke patients concerning in-patient or out-patient neurological rehabilitation in Phase D]. / Erwartungen von Schlaganfall-Rehabilitanden an die stationäre und teilstationäre neurologische Rehabilitation in der Phase D.

Setting preferences and expectations before and appraisals and criticisms after neurological rehabilitation of stroke patients who fulfilled German phase-D criteria (cooperative and independent in basic ADL-functions) were longitudinally assessed in a rehabilitation centre with in-patient and out-patient facilities of comparable therapeutic quality and intensities, and followed-up for 6 months. 53 patients fulfilled inclusion criteria, of whom 16 opted for and received out-patient rehabilitation, 21 opted for out-patient rehabilitation but had to receive in-patient treatment mainly for geographical reasons, and 16 preferred and received in-patient rehabilitation. Setting preferences and setting assignment did not influence patients' expectations. When assessed at discharge and after 6 months, a considerable number of patients expressed changes in setting preferences and altered reasons for setting choice. At rehabilitation onset, patients were generally optimistic that rehabilitation would lead to an improvement of functional abilities and health status. This optimism was not fulfilled, although patients improved in functional independence/activities of daily life and physical dimensions of quality of life. The subjective realization of expectations was neither associated with setting preference nor with realized setting. Improvements of functional disabilities and independence were not correlated with rehabilitation satisfaction. Patients were less disappointed with rehabilitation outcome the more they improved in dimensions of quality of life (or vice versa). The fact that setting preferences are indifferent and not stable over time indicates deficits of information and decision capacity in rehabilitation patients after stroke and may be explained by characteristics of this disease and a specific, short time-limit for decision-making. For the evaluation of rehabilitation programmes, it can also be concluded that multidimensional assessments such as the SF-36 cannot be replaced by patient satisfaction scores.

[Results of in- vs outpatient post-stroke rehabilitation over 6 months]. / Ergebnisse der ambulanten und stationären Rehabilitation in den ersten sechs Monaten nach Schlaganfall.

In a prospective longitudinal study, stroke patients with largely intact ADL-functions who were treated in a rehabilitation center were assessed at the beginning and end of rehabilitation treatment and 6 months afterwards. They were treated as outpatients, if they expressed a preference for this setting and if outpatient rehabilitation was logistically and geographically possible, otherwise as inpatients. We found medium- to large-size gains for physical and ADL function and associated quality-of-life dimensions (WHOQOL-BREF, SF-36). However, there were also losses in other aspects of quality of life, e. g. in the social domain. There were no differences with respect to type of setting. Patients' setting preferences influenced the development of perception of own health. There was only a small and insignificant influence of satisfaction with rehabilitation treatment. We propose an expansion of neurological outpatient rehabilitation services and a focus on factors outside the rehabilitation system that influence quality of life.

[Short term results of outpatient vs. inpatient rehabilitation after stroke]. / Kurzfristige Ergebnisse ambulanter vs. stationärer Phase-D-Rehabilitation nach Schlaganfall.

Fifty stroke patients who had already regained basic ADL-functions were investigated at the beginning and end of either inpatient or outpatient rehabilitation of similar therapeutic intensity in the same institution. For geographic reasons, outpatient treatment could only be offered to a subgroup of patients. Neurological deficits, extended ADL-functions and quality of life (SF-36) were assessed. Patients who chose outpatient rehabilitation exhibited milder neurological deficits and better ADL-function at onset. On average, outpatient rehabilitation took about 8 days more than inpatient treatment. Under rehabilitation, gains with respect to ADL-functions and the QoL-dimensions "physical role function" and "physical functional ability" were realized. The magnitude of changes did not depend on setting. A decrease in "general health perception" may be related to the inpatient treatment of patients who would have preferred an outpatient setting. Brief periods between stroke and onset of rehabilitation and longer duration of rehabilitation treatment were significantly associated with better outcome with respect to ADL-functions.

The effect of laterality of stimulus presentation on auditory P300 topography in schizophrenia.

Reduced P300 amplitude in schizophrenia has been a consistent finding. Recent studies have raised the question of characteristic topographic distribution. This study reports the effects of binaural and unilateral stimuli on the P300 topography in schizophrenia. An auditory "oddball" paradigm was repeated 3 times with left, right and binaural stimulation. Data were recorded using a 19-electrode montage with linked ear reference. Subjects were 18 untreated, hallucinating, paranoid patients with schizophrenia and 24 healthy matched volunteers. For the control subjects, stimulus conditions had no effect on P300 topography. For the sample with schizophrenia, topography under unilateral left stimulation resembled that of control subjects. Binaural and right-sided stimulation shifted peak amplitudes to the right and frontally. In addition to the usually observed parietal peak, a second P300 maximum having a different time course appeared over right frontal areas. The data provide further support for lateralized dysfunction in schizophrenia.

Cyclandelate versus propranolol in the prophylaxis of migraine--a double-blind placebo-controlled study.

The aim of the present study was to ascertain the comparative efficacy of cyclandelate, a migraine prophylactic with calcium overload blocking properties, versus propranolol, a non-selective beta-adrenergic blocker, and placebo. Based on different statistical analysis procedures (including time series analysis) a responder and nonresponder evaluation for cyclandelate and propranolol was performed. In addition, an attempt was made to identify the dose relationship of the various drugs on headache parameters. In a double-blind placebo-controlled study 84 patients were treated in a placebo run-in phase (4 weeks). The patients were then randomized by the statistical criterion of placebo responder and nonresponder to either the cyclandelate or the propranolol group. The total treatment period included a low-dosage phase (8 weeks) and high-dosage phase (8 weeks). All patients kept a headache diary before, during and after treatment. The data were assessed by time series analysis (ARIMA), as well as by analysis of variance and nonparametric statistics. Based on ARIMA statistics, 39.3% of the patients showed a significant improvement of migraine during treatment with cyclandelate compared with 29.4% placed on propranolol. Higher doses of cyclandelate and propranolol were more effective. Using the qualitative response-criterion of a 50% reduction in migraine symptoms, cyclandelate showed a response in 67.9% and propranolol in 41.2% of all cases. It can therefore be concluded that cyclandelate as well as propranolol are two comparable substances in the prophylactic treatment of migraine, with cyclandelate showing fewer side effects.

Multivariate EEG power spectral analysis in acute schizophrenics.

The electroencephalogram (EEG) during information processing is influenced by specific changes in brain electrical activity. Based on the theory of disturbed information processing in schizophrenics, we analysed auditory stimulus induced EEG changes by Fast Fourier Transformation. The most important of the significant stimulation-dependent EEG power changes were measured in the 0.5-3.5 Hz and 10-13.5 Hz frequency bands in the left frontoparietal lead. In a multivariate analysis the separation of the subjects examined into acute schizophrenics and normals was incorrect in only 21% of the cases (resubstitution rate); using pi-method an error of 31% was estimated.

Repeated acoustic stimulation of acute schizophrenic patients and the habituation of EEG power changes.

Habituation in psychiatric patients to repeated stimuli has typically been described in connection with the measurement of the skin conductance orienting response. Here EEG power spectra of acute schizophrenic patients and normals to 4 trials of an acoustic stimulation were examined for evidence of habituation. In response to stimulation the alpha EEG reactivity was less distinct in schizophrenics than in normals. This is in agreement with the theory of hypovariability or hyperstability of the EEG in schizophrenics. Signs of habituation in acute schizophrenics were clearer in fast beta frequencies of the parietal leads.

[Multivariate discriminant analysis of EEG power spectra in acute schizophrenic patients and healthy probands]. / Multivariate Diskriminanzanalyse von EEG-Leistungsspektren akut Schizophrener und Gesunder.

The electroencephalogram (EEG) during information processing is influenced by specific changes in brain electrical activity. Based on the theory of a disturbed information processing in schizophrenics we analysed auditory stimulus induced EEG changes by Fast Fourier Transformation. The most important of the significant stimulation dependent EEG power changes were measured in the 0.5-3.5 Hz and 10-13.5 Hz frequency bands in the left parietal lead. In a multivariate analysis the separation of the subjects examined into acute schizophrenics and normals was incorrect in only 21% of the cases (resubstitution rate): using the pi-method an error of 31% was estimated.