DOC-BOX, PI: Aurore Thibaut (Liège), 2024-2027, EU: HORIZON-MSCA-2022-SE-01-01

This European project entitled “Development of a multimodal toolbox to ensure a fast and reliable diagnosis of consciousness disorders” is being carried out by 16 European partner institutions. The aim is to improve the clinical and technical (e.g. electrophysiology) diagnosis of patients with severe disorders of consciousness (DoC) by developing and evaluating new clinical assessments and automated analysis pipelines for multimodal diagnostics, such as high-resolution EEG (HD-EEG) or fMRI.

Does the Affolter Method® work the same as standard therapy for apraxia?

Rehabilitation of Apraxia Using the Affolter Model®

Project title: Apraxia Post-Stroke Affolter Rehabilitation Trial (APART)

Project Overview

Project type: Research project

Duration: 3 years

Status: ongoing/ in preparation

Medical Relevance

Apraxia affects approximately one third of patients following a stroke and impairs the execution of everyday activities despite fundamentally preserved motor functions. It represents an independent predictor of functional limitations, need for care, and reduced independence. Apraxia scores collected at the beginning of rehabilitation already allow a concrete prognosis regarding long-term daily living competence (Barthel Index). Apraxia therefore holds high diagnostic and prognostic significance in rehabilitation.

For established therapeutic approaches such as strategy training and gesture training, there is already evidence of positive effects on everyday functioning. Nevertheless, there remains a clinical need for therapeutic approaches that support patients in transferring skills to complex, real-life everyday activities and that also address core deficits in action planning, perceptual organization, and action execution. The Affolter Model® additionally relies on sensorimotor-guided learning in realistic everyday situations and aims to support the transfer of therapeutically learned actions into daily life. Although the Affolter Model® is established in clinical practice and its key components were recently described systematically in a multiprofessional Delphi study, its effectiveness in stroke patients with apraxia has not yet been sufficiently investigated under controlled conditions.

Against this background, the APART study examines whether treatment based on the Affolter Model® — compared to standard guideline-oriented therapy — has an effect on the functional independence and apraxia symptoms of patients following a stroke.

Objectives

• Evaluation of the effectiveness of the Affolter Method® in apraxia patients
• Comparison with standard guideline-oriented therapy with regard to functional independence and apraxia symptomatology

• Prospective randomized clinical bi-national study at 2 centers
• Comparison of current standard therapy and the Affolter Model®

• First-ever clinical investigation of the Affolter Model®

How reliable are prognoses in disorders of consciousness?

Outcome Prediction after Severe Brain Injury

Project title: Outcome Prediction in Disorders of Consciousness following Severe Brain Injury: Analysis of Valid Prognostic Predictors from Clinical Guidelines

Project Overview

Project type: PhD project

Duration: 3 years

Status: ongoing

Medical Relevance

Decisions about the withdrawal of life-sustaining measures are frequently based on neurological prognoses. But how reliable are these predictions actually? A central problem is the risk of self-fulfilling prophecy: if treatment is discontinued on the basis of a poor prognosis, the affected person dies — regardless of whether the prognosis was correct. The true recovery potential thus remains systematically unknown. Misassessments can therefore not only seal individual fates, but also distort the data on which future prognoses are based. The aim of this project is to critically examine and improve the scientific basis for such decisions.

Objectives

• Validation of prognostic criteria from German and European clinical guidelines
• Examination of their transferability to real clinical decision-making situations

• Analysis of two prospectively collected clinical datasets
• Comparison of existing prognostic models with real-world outcomes
• Development and evaluation of a new prediction model

• Explicit addressing of the self-fulfilling prophecy problem in prognosis research
• Expanded outcome definition: not only the regaining of consciousness, but the degree of functional recovery and independence as the primary target criterion

OptiNIV, PI/Consortium Leadership Prof. Dr. Andreas Bender, 2021-2025, G-BA/Innovationsfonds

OptiNIV (www.optiniv.de) is about optimizing the post-hospital intensive care of neurological rehabilitation patients. Unfortunately, around 30% of neurological early rehabilitation patients (e.g. after a stroke or traumatic brain injury) are unable to be weaned off ventilation and/or tracheostomy tubes. After completing rehabilitation treatment, patients are discharged to out-of-hospital intensive care (OHIC), which focuses more on maintaining their condition than improving it. As part of the Bavaria-wide OptiNIV project, mobile teams of experts from neurological rehabilitation clinics continue to care for OHIC patients after discharge and aim to wean them off tracheostomy tubes and/or ventilation within a year through a combination of outpatient and inpatient diagnostics and therapy.

PerBrain (ERAPerMed 2019), PI: Jacobo Sitt (Paris), 2020-2025, BMBF

“A Multimodal Approach to Personalized Tracking of Evolving State-Of Consciousness in Brain-lnjured Patients” is a multicentre prospective cohort study of patients who have suffered a severe Disorder of Consciousness (DoC) after an acute brain injury. These patients are misdiagnosed in up to 40% of cases, partly due to the difficulty of making a reliable clinical diagnosis of DoC. In the PerBrain project with partners in Paris, Milan and Tel Aviv, DoC patients are therefore not only examined clinically (CRS-R) but also multimodally with MRI, PET, HD-EEG, quantification of the reaction to odors and TMS/EEG.