H. Karbe - Academia.edu (original) (raw)
Papers by H. Karbe
Klinische Neurophysiologie, 2007
Klinische Neurophysiologie, 2009
Die Rehabilitation, 2001
Until recently, major methodological problems were faced in the assessment and rehabilitation of ... more Until recently, major methodological problems were faced in the assessment and rehabilitation of driving ability in neurological patients, concerning practical driving lessons and driving tests as well as neuropsychological tests and therapies. The use of highly-advanced driving simulators may solve parts of this problem. However, a basic requirement for effective rehabilitation is the patients' acceptance of this method. In a semi-standardized interview with 56 patients we found that the driving simulator recently installed in the Neurological Rehabilitation Centre "Godeshöhe" was rated mainly positively. Also, patients experienced the simulator to be motivating, effective and informative. Hence, a very important prerequisite for successful use of driving simulators in neurological rehabilitation is given.
Advances in neurology, 1997
Archives of neurology, 1995
To describe the registered analysis of magnetic resonance imaging and glucose metabolic data acqu... more To describe the registered analysis of magnetic resonance imaging and glucose metabolic data acquired with positron emission tomography to determine the relationship between structure and function of temporal lobe cortical structures between the left and right hemispheres. The dominance of the left cerebral hemisphere is associated with a preponderance of the left planum temporale. Fifteen subjects without signs or symptoms of a neurological disorder. Three-dimensional-registered magnetic resonance imaging and positron emission tomography with the use of fludeoxyglucose F18 and a high-resolution positron emission tomography scanner. Analysis of regional metabolic activation during single-word repetition on matched parasagittal magnetic resonance imaging and positron emission tomography. The planum temporale was bilaterally activated without left-right asymmetry. The metabolic increase was asymmetric within the left Brodmann's area (BA) 22. The part of the left BA 22 that was bur...
Patients with dementia of the Alzheimer type (DAT) have been studied with many brain imaging proc... more Patients with dementia of the Alzheimer type (DAT) have been studied with many brain imaging procedures. The results demonstrated the superiority of Positron Emission Tomography (PET) over structural imaging in the separation of DAT patients and controls. The P 300 being another functional parameter is also reported to be highly specific and sensitive in dementia. We present the preliminary results of an ongoing 2-year-prospective study. The first 17 consecutive patients (13 females, 4 males; mean age 66, range 52-76 years) with probable Alzheimer's disease using NINCDS-ADRDA criteria were examined. Based upon the 7point Global Deterioration Scale (GDS), the severity ranged from mild to moderate (GDS 3-6). The regional cerebral glucose metabolism (rCMRGlu) was studied with 18 F-2-fluoro2-deoxyglucose and PET. Standardized regional quantitation was achieved using an interactive mapping program. The P 300 was elicited within a two-tone auditory "oddball" paradigm according to Maurer et al. using a Biologic Brain Atlas System III. Two identical runs were presented. Amplitude, latency and spatial distribution of P 300 were analyzed in comparison with an age matched control group. 16 patients showed a pattern of rCMRGlu which is supposed to be typical for Alzheimer's disease: a predominantly regional hypometabolism in the posterior parietal and temporal cortex. In one patient there was the main decrease of glucose utilization in the frontal association area. The overall reduction of global metabolism was 9%. The P 300 showed a considerable variability of all parameters not only inter- but also intraindividually regardless of the severity of the dementia. A possible explanation for the discrepancy of PET and P 300 might be the influence of the affective state of the patients (anxiety, tension, uneasiness) on the P 300 component.
Klinische Neurophysiologie, 2007
Die Rehabilitation, 2009
Established by the Federal Ministry of Labour and Social Affairs (BMAS) in October 2007, the Scie... more Established by the Federal Ministry of Labour and Social Affairs (BMAS) in October 2007, the Scientific Expert Group RehaFutur had been commissioned to elaborate cornerstones for the medium- and long-term development of vocational rehabilitation of adults with disabilities (re-integration). Initial questions inter alia were as follows: Which function should vocational rehabilitation have in a service- and knowledge-oriented working world that will increasingly be affected by demographic change? How can disabled persons' right to occupational participation by way of vocational rehabilitation, a right stipulated both under the German constitution and in German law, be realized as needed also in the future? Various fields of action have been derived on the basis, for one, of an investigation of the factors, social law, social and education policy as well as European, influencing vocational rehabilitation and, for the other, of an evaluation of current labour market and demographic developments. Dealt with in the fields of action outlined are the aspects: equitable opportunities of access, developmental and needs orientation, closeness to the real occupational and working world, as well as the role of self-determination and self-responsibility. The fields of action are to be understood as framework concept for shaping a cross-actor innovation process. Sustainable vocational rehabilitation is characterized in particular by the fact that it is specifically targeted at promoting disabled persons' self-determination and self-responsibility actively using these in the process and that it strengthens an independent lifestyle, ensures social participation by inclusive structures; also, it facilitates continued participation in working life by ongoing education involving holistic development of professional and personal competencies oriented towards the individual's resources and potentials, safeguarding it by systematic networking with companies. The concept presented for vocational rehabilitation of adults with disabilities encompasses a change of paradigms which service carriers and providers will have to face jointly and including the service users, the rehabilitants.
Klinische Neurophysiologie, 2008
Die Rehabilitation, 2013
ABSTRACT MEmbeR is a prospective multi-center study on medical-occupational rehabilitation in Ger... more ABSTRACT MEmbeR is a prospective multi-center study on medical-occupational rehabilitation in Germany.196 neurological, psychiatric, orthopaedic, and internal medicine patients from 21 rehabilitation centres all across Germany have been enrolled and followed-up for 2 years after discharge. Primary outcome parameter was defined as return to work. Further, the SF-12 and a Mini-ICF-Rating have been used.Mean age was 34.1 (9.9) years, length of stay 150.0 (223.5) days. Prior to occupational rehabilitation, 69.9% were unable to work, 2 years after discharge only 5.6%. Rate of participants seeking a job was reduced from 19.7% to 3.1%. In summary, 78.1% returned to work. Employed participants were younger (32.8 [9.7] vs. 38.5 [9.4] years, p=0.001) and less disabled (Degree of Disablement [GdB]: 20.0 [31.2] vs. 36.1 [33.7], p<0.05).The multicenter cohort study MEmbeR provides further knowledge about the outcome of medical-occupational rehabilitation in Germany.
Frontiers in Human Neuroscience, 2013
Stroke, 2000
In a prospective, double-blind, placebo-controlled study, it was investigated whether piracetam i... more In a prospective, double-blind, placebo-controlled study, it was investigated whether piracetam improves language recovery in poststroke aphasia assessed by neuropsychological tests and activation PET measurement of cerebral blood flow. Twenty-four stroke patients with aphasia were randomly allocated to 2 groups: 12 patients received 2400 mg piracetam twice daily, 12 placebo. Before and at the end of the 6-week treatment period in which both groups received intensive speech therapy, the patients were examined neuropsychologically and studied with H(2)(15)O PET at rest and during activation with a word-repetition task. Blood flow was analyzed in 14 language-activated brain regions defined on reconstructed surface views from MRI coregistered to the PET images. Before treatment, both groups were comparable with respect to performance in language tasks and to type and severity of aphasia. In the piracetam group, increase of activation effect was significantly higher (P:<0.05) in the left transverse temporal gyrus, left triangular part of inferior frontal gyrus, and left posterior superior temporal gyrus after the treatment period compared with the initial measures. The placebo group showed an increase of activation effect only in the left vocalization area. In the test battery, the piracetam group improved in 6 language functions, the placebo group only in 3 subtests. Piracetam as an adjuvant to speech therapy improves recovery of various language functions, and this effect is accompanied by a significant increase of task-related flow activation in eloquent areas of the left hemisphere.
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2008
Neuroscience Letters, 1994
Neurorehabilitation and Neural Repair, 2008
Neuroradiology, 1994
A computer-assisted mapping program was developed to determine changes of cerebral perfusion in n... more A computer-assisted mapping program was developed to determine changes of cerebral perfusion in normal and pathological aging using single photon emission computer tomography (SPECT) and 99mTc-hexamethylpropyleneamine oxime (HMPAO). The software program outlined the cortex on 14 adjacent brain slices, and superimposed a ring of 12 regions of interest on each slice. Regional/global and regional/cerebellar relative flow values were calculated in 27 patients with clinically diagnosed Alzheimer's disease (AD) (mean age 71 years, SD 7.6) and in 10 normal controls (mean age 73.7 years, SD 7.3). The Dementia Rating Scale (DRS) was used to assess mental status in all subjects. Multiple regression analysis demonstrated a significant correlation between relative flow values and the DRS score. Regional/cerebellar (R = 0.88, p < 0.0001) relative flow values were a better indicator of cortical impairment than regional/global relative flow values (R = 0.68, p = 0.003). Of the brain regions of interest, the left parietal flow values correlated best with the DRS score (r = 0.83, p < 0.0001), a cutoff value of 77 accurately classifying 80% of the normals and 100% of the patients diagnosed as having Alzheimer's disease. The data show that computer-assisted mapping of SPECT can provide semiquantitative flow values with high diagnostic accuracy.
NeuroImage, 1996
Examination of the individual functional anatomy of language is of particular interest in clinica... more Examination of the individual functional anatomy of language is of particular interest in clinical neurology to explain the variability of aphasic symptoms after focal lesions and to avoid damage of language-related brain areas by surgery. For a silent verb generation task, we examined whether activation PET with 3D data acquisition, multiple replication of conditions, and coregistration with MRI provides results that are consistent and reproducible enough to be useful clinically. Visual analysis was performed on PET-MRI fusion images, including renderings of the brain surface. Quantitative analysis was based on volumes of interest. In seven right-handed normals, activation of the triangular part of the left inferior frontal cortex [Brodman area (BA) 45] was the most significant finding that was present in each subject. Two subjects showed minor anatomical variants of the ascending or horizontal ramus of the sylvian fissure that were associated with the least activation of BA 45. In the left hemisphere the other frontal gyri, the superior temporal and posterior part of the middle temporal gyrus, and the paracingulate gyrus were also significantly activated. There was significant bilateral cerebellar activation, but it was significantly more intense on the right than on the left side. The consistency and high interindividual reproducibility of these findings suggest that this technique may be useful for clinical assessment of language-related areas.
Klinische Neurophysiologie, 2007
Klinische Neurophysiologie, 2009
Die Rehabilitation, 2001
Until recently, major methodological problems were faced in the assessment and rehabilitation of ... more Until recently, major methodological problems were faced in the assessment and rehabilitation of driving ability in neurological patients, concerning practical driving lessons and driving tests as well as neuropsychological tests and therapies. The use of highly-advanced driving simulators may solve parts of this problem. However, a basic requirement for effective rehabilitation is the patients' acceptance of this method. In a semi-standardized interview with 56 patients we found that the driving simulator recently installed in the Neurological Rehabilitation Centre "Godeshöhe" was rated mainly positively. Also, patients experienced the simulator to be motivating, effective and informative. Hence, a very important prerequisite for successful use of driving simulators in neurological rehabilitation is given.
Advances in neurology, 1997
Archives of neurology, 1995
To describe the registered analysis of magnetic resonance imaging and glucose metabolic data acqu... more To describe the registered analysis of magnetic resonance imaging and glucose metabolic data acquired with positron emission tomography to determine the relationship between structure and function of temporal lobe cortical structures between the left and right hemispheres. The dominance of the left cerebral hemisphere is associated with a preponderance of the left planum temporale. Fifteen subjects without signs or symptoms of a neurological disorder. Three-dimensional-registered magnetic resonance imaging and positron emission tomography with the use of fludeoxyglucose F18 and a high-resolution positron emission tomography scanner. Analysis of regional metabolic activation during single-word repetition on matched parasagittal magnetic resonance imaging and positron emission tomography. The planum temporale was bilaterally activated without left-right asymmetry. The metabolic increase was asymmetric within the left Brodmann's area (BA) 22. The part of the left BA 22 that was bur...
Patients with dementia of the Alzheimer type (DAT) have been studied with many brain imaging proc... more Patients with dementia of the Alzheimer type (DAT) have been studied with many brain imaging procedures. The results demonstrated the superiority of Positron Emission Tomography (PET) over structural imaging in the separation of DAT patients and controls. The P 300 being another functional parameter is also reported to be highly specific and sensitive in dementia. We present the preliminary results of an ongoing 2-year-prospective study. The first 17 consecutive patients (13 females, 4 males; mean age 66, range 52-76 years) with probable Alzheimer's disease using NINCDS-ADRDA criteria were examined. Based upon the 7point Global Deterioration Scale (GDS), the severity ranged from mild to moderate (GDS 3-6). The regional cerebral glucose metabolism (rCMRGlu) was studied with 18 F-2-fluoro2-deoxyglucose and PET. Standardized regional quantitation was achieved using an interactive mapping program. The P 300 was elicited within a two-tone auditory "oddball" paradigm according to Maurer et al. using a Biologic Brain Atlas System III. Two identical runs were presented. Amplitude, latency and spatial distribution of P 300 were analyzed in comparison with an age matched control group. 16 patients showed a pattern of rCMRGlu which is supposed to be typical for Alzheimer's disease: a predominantly regional hypometabolism in the posterior parietal and temporal cortex. In one patient there was the main decrease of glucose utilization in the frontal association area. The overall reduction of global metabolism was 9%. The P 300 showed a considerable variability of all parameters not only inter- but also intraindividually regardless of the severity of the dementia. A possible explanation for the discrepancy of PET and P 300 might be the influence of the affective state of the patients (anxiety, tension, uneasiness) on the P 300 component.
Klinische Neurophysiologie, 2007
Die Rehabilitation, 2009
Established by the Federal Ministry of Labour and Social Affairs (BMAS) in October 2007, the Scie... more Established by the Federal Ministry of Labour and Social Affairs (BMAS) in October 2007, the Scientific Expert Group RehaFutur had been commissioned to elaborate cornerstones for the medium- and long-term development of vocational rehabilitation of adults with disabilities (re-integration). Initial questions inter alia were as follows: Which function should vocational rehabilitation have in a service- and knowledge-oriented working world that will increasingly be affected by demographic change? How can disabled persons&amp;#39; right to occupational participation by way of vocational rehabilitation, a right stipulated both under the German constitution and in German law, be realized as needed also in the future? Various fields of action have been derived on the basis, for one, of an investigation of the factors, social law, social and education policy as well as European, influencing vocational rehabilitation and, for the other, of an evaluation of current labour market and demographic developments. Dealt with in the fields of action outlined are the aspects: equitable opportunities of access, developmental and needs orientation, closeness to the real occupational and working world, as well as the role of self-determination and self-responsibility. The fields of action are to be understood as framework concept for shaping a cross-actor innovation process. Sustainable vocational rehabilitation is characterized in particular by the fact that it is specifically targeted at promoting disabled persons&amp;#39; self-determination and self-responsibility actively using these in the process and that it strengthens an independent lifestyle, ensures social participation by inclusive structures; also, it facilitates continued participation in working life by ongoing education involving holistic development of professional and personal competencies oriented towards the individual&amp;#39;s resources and potentials, safeguarding it by systematic networking with companies. The concept presented for vocational rehabilitation of adults with disabilities encompasses a change of paradigms which service carriers and providers will have to face jointly and including the service users, the rehabilitants.
Klinische Neurophysiologie, 2008
Die Rehabilitation, 2013
ABSTRACT MEmbeR is a prospective multi-center study on medical-occupational rehabilitation in Ger... more ABSTRACT MEmbeR is a prospective multi-center study on medical-occupational rehabilitation in Germany.196 neurological, psychiatric, orthopaedic, and internal medicine patients from 21 rehabilitation centres all across Germany have been enrolled and followed-up for 2 years after discharge. Primary outcome parameter was defined as return to work. Further, the SF-12 and a Mini-ICF-Rating have been used.Mean age was 34.1 (9.9) years, length of stay 150.0 (223.5) days. Prior to occupational rehabilitation, 69.9% were unable to work, 2 years after discharge only 5.6%. Rate of participants seeking a job was reduced from 19.7% to 3.1%. In summary, 78.1% returned to work. Employed participants were younger (32.8 [9.7] vs. 38.5 [9.4] years, p=0.001) and less disabled (Degree of Disablement [GdB]: 20.0 [31.2] vs. 36.1 [33.7], p<0.05).The multicenter cohort study MEmbeR provides further knowledge about the outcome of medical-occupational rehabilitation in Germany.
Frontiers in Human Neuroscience, 2013
Stroke, 2000
In a prospective, double-blind, placebo-controlled study, it was investigated whether piracetam i... more In a prospective, double-blind, placebo-controlled study, it was investigated whether piracetam improves language recovery in poststroke aphasia assessed by neuropsychological tests and activation PET measurement of cerebral blood flow. Twenty-four stroke patients with aphasia were randomly allocated to 2 groups: 12 patients received 2400 mg piracetam twice daily, 12 placebo. Before and at the end of the 6-week treatment period in which both groups received intensive speech therapy, the patients were examined neuropsychologically and studied with H(2)(15)O PET at rest and during activation with a word-repetition task. Blood flow was analyzed in 14 language-activated brain regions defined on reconstructed surface views from MRI coregistered to the PET images. Before treatment, both groups were comparable with respect to performance in language tasks and to type and severity of aphasia. In the piracetam group, increase of activation effect was significantly higher (P:<0.05) in the left transverse temporal gyrus, left triangular part of inferior frontal gyrus, and left posterior superior temporal gyrus after the treatment period compared with the initial measures. The placebo group showed an increase of activation effect only in the left vocalization area. In the test battery, the piracetam group improved in 6 language functions, the placebo group only in 3 subtests. Piracetam as an adjuvant to speech therapy improves recovery of various language functions, and this effect is accompanied by a significant increase of task-related flow activation in eloquent areas of the left hemisphere.
RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2008
Neuroscience Letters, 1994
Neurorehabilitation and Neural Repair, 2008
Neuroradiology, 1994
A computer-assisted mapping program was developed to determine changes of cerebral perfusion in n... more A computer-assisted mapping program was developed to determine changes of cerebral perfusion in normal and pathological aging using single photon emission computer tomography (SPECT) and 99mTc-hexamethylpropyleneamine oxime (HMPAO). The software program outlined the cortex on 14 adjacent brain slices, and superimposed a ring of 12 regions of interest on each slice. Regional/global and regional/cerebellar relative flow values were calculated in 27 patients with clinically diagnosed Alzheimer's disease (AD) (mean age 71 years, SD 7.6) and in 10 normal controls (mean age 73.7 years, SD 7.3). The Dementia Rating Scale (DRS) was used to assess mental status in all subjects. Multiple regression analysis demonstrated a significant correlation between relative flow values and the DRS score. Regional/cerebellar (R = 0.88, p < 0.0001) relative flow values were a better indicator of cortical impairment than regional/global relative flow values (R = 0.68, p = 0.003). Of the brain regions of interest, the left parietal flow values correlated best with the DRS score (r = 0.83, p < 0.0001), a cutoff value of 77 accurately classifying 80% of the normals and 100% of the patients diagnosed as having Alzheimer's disease. The data show that computer-assisted mapping of SPECT can provide semiquantitative flow values with high diagnostic accuracy.
NeuroImage, 1996
Examination of the individual functional anatomy of language is of particular interest in clinica... more Examination of the individual functional anatomy of language is of particular interest in clinical neurology to explain the variability of aphasic symptoms after focal lesions and to avoid damage of language-related brain areas by surgery. For a silent verb generation task, we examined whether activation PET with 3D data acquisition, multiple replication of conditions, and coregistration with MRI provides results that are consistent and reproducible enough to be useful clinically. Visual analysis was performed on PET-MRI fusion images, including renderings of the brain surface. Quantitative analysis was based on volumes of interest. In seven right-handed normals, activation of the triangular part of the left inferior frontal cortex [Brodman area (BA) 45] was the most significant finding that was present in each subject. Two subjects showed minor anatomical variants of the ascending or horizontal ramus of the sylvian fissure that were associated with the least activation of BA 45. In the left hemisphere the other frontal gyri, the superior temporal and posterior part of the middle temporal gyrus, and the paracingulate gyrus were also significantly activated. There was significant bilateral cerebellar activation, but it was significantly more intense on the right than on the left side. The consistency and high interindividual reproducibility of these findings suggest that this technique may be useful for clinical assessment of language-related areas.