cereneo Schweiz AG, Specialist and referring doctors
cereneo Schweiz AG, Specialist and referring doctors

cereneo is specialised in the therapy approach and the high intensity of the treatments. Thanks to the close relationship between the clinic and the world of science, cereneo is always at the forefront of research. The latest measurement processes and newest therapeutic possibilities are used here.

The worldwide network of specialists and the proximity and cooperation with universities not only motivate the team but also enable the patient to make the best possible progress.

cereneo therapy concept

Neurological illness / acute treatment

Damage to the central nervous system often results in a loss of different bodily functions (e.g. speaking, swallowing, cognitive and movement functions) with direct and indirect consequences for many areas of daily life. This damage can arise, amongst other things, as a result of strokes, multiple sclerosis, Parkinson's disease or craniocerebral injury.

Symptoms

The rehabilitation process starts with the precise analysis and characterisation of the symptoms and deficits. The complexity of the limitations requires an interdisciplinary approach to therapy, whereby the different professional groups work closely together. Intensive and targeted training based around daily life is necessary to support the recovery of brain functions and the ability to relearn tasks from everyday life. In order to identify the areas to be trained, the process starts with the doctor and therapist carefully recording the symptoms and performing an exact analysis of the deficits using technical measurement processes. This includes walking analysis with 3D movement measurements and power and muscle activity measurements or surrogate markers from magnetic resonance imaging, evoked potential or EEGs.

Patient's goal

The overriding goal is to work together with patients to offer them the greatest degree of independence in their living situation and continually improve their quality of life. The goals of the therapy are defined taking into account the patient's moral views and the individual wishes of the patient and their relatives.

Therapy

As part of the cereneo therapy concept a patient-specific therapy programme is developed at the start of each rehabilitation phase. The therapy combines various training methods, which all attempt to achieve maximum therapy intensity (duration); this is determined by the performance and motivation of the patient.

INDIVIDUAL INTENSITY
The following therapies are used:

  • Manual movement therapy (physiotherapy/ergotherapy) is based on the concept of forced use, whereby exercises that progressively always demand maximum effort from the patient are used to modify movement patterns towards physiological movement
  • Robot-supported movement training for the arm (Armeo Power, Armeo Spring, Hocoma AG, Volketswil, Switzerland; Amadeo, Tyromotion GmbH, Graz, Austria) and leg (Lokomat, Hokoma AG)
  • Dynamic partial weight release (Zero G, Aretech LLC Ashburn, USA)
  • Dynamic power and precision training for the legs (Allegro, Dynamic Devices AG, Zurich, Switzerland)
  • Virtual reality and mirror training (YouRehab, Schlieren, Switzerland)
  • SplitBelt treadmill training (Bertec Inc, Columbus, USA)
  • Speech and speaking therapy
  • Training of swallowing and tongue movement
  • Neurocognitive training (exercises, computer programmes) in neuropsychology

Alongside these, we also use supporting rehabilitative procedures:

  • Transcranial DC stimulation (tDCS)
  • Repetitive transcranial magnetic stimulation (rTMS)
  • Medicinal therapy approaches

FLEXIBILITY HAND IN HAND
Interdisciplinary cooperation is very important and, whenever required, specialist areas are combined for specific treatments to support the patient in the best way possible.

RESEARCH & TECHNOLOGY
Research forms the basis for personalised treatments at the highest level. Research and treatment go hand in hand at cereneo. Thanks to the close connection between the clinic and the world of science, cereneo is always at the forefront of knowledge and deploys the latest measuring processes and the newest therapeutic possibilities. Particularly in a relatively new research field such as neurorehabilitation the latest results must be critically evaluated before they can be integrated into a treatment.
cereneo performs basic and clinical research. As a research clinic cereneo uses complex technologies (structural and functional MRI, EEG, TMS) when researching brain recovery and developing new therapy approaches. The processes for measuring brain anatomy and function, for brain stimulation and movement analysis create instruments used for helping to answer important questions in the field of neurorehabilitation.

MOTIVATION
During the course of the treatment continual measurements and assessments illustrate the recovery progress.
Every day the patient is informed by their reference person about their training performance and improvements – a significant factor for motivation. Research and development at cereneo also play an important role here.

Assessment

For example, a monitoring and feedback system is developed that - in a similar way to the activity trackers commonly used nowadays in the field of leisure - can record the patient's therapy and sometimes also leisure activities and provide daily summaries. During regular interdisciplinary conferences, neurologists, physiotherapists, occupational therapists, speech therapists, neuropsychologists, nutritionists and experts on rehabilitative care meet to define, review, document and potentially adjust the therapeutic approach. If adjustments are required, the symptoms are reassessed and corresponding therapy measures identified. The effectiveness of these measures is again reviewed through regular measurements and assessments.



Testimonial Dr. Kai Lutz

"cereneo offers a unique connection between modern neurorehabilitation and the bases of neuro-scientific research. The imaging techniques used on our premises and the highly modern laboratory enable us to record precisely the patient's progress. The biggest motivator for me is experiencing this directly and performing the ongoing therapies tailored to the individual needs of the patient."

Dr. Kai Lutz, Scientific Director

Research projects

Study on improving arm function after strokes through intensive training 2 – SMARTS 2

SMARTS 2 is a randomised, blind, multi-centric study that investigates the effect of intensive robot therapy on the arm after a stroke.
A stroke often leads to limitations in arm movement that does not fully return for many patients. Intensive training is important for complete regeneration. The robot therapy represents a promising opportunity for patients after a stroke. However, it is unclear whether the robot therapy is superior to standard neurorehabilitation.

Our research question here is as follows: can arm movement be improved by patients receiving robot therapy after a stroke rather than a standard therapy?

Interaction – observation of stroke patients in the clinic and at home

Interaction is an observational study, whereby the movements of stroke patients are observed using a sensor-based whole body suit at cereneo and then at home after their release.

The aim of the study is to review the quality and quantity of movements in daily life, in order to follow improvements or deteriorations in the use of arms and legs during the rehabilitation process.

Increased motivation and optimised intensity in stroke rehabilitation

During stroke rehabilitation it is important that the affected patients train intensively and actively during their stay in the rehabilitation clinic. When it comes to optimising the patient's training activities, clinics are normally restricted by limitations in personnel and the infrastructure. At cereneo different approaches for increasing the intensity of the therapy are implemented and verified on the basis of studies. The aim is to increase the patient's motivation through various interventions to raise the intensity of the training. Outside of the therapies performed, the patients also have various opportunities for self-training, so that they can use their stay in the clinic to the full. To be able to use the infrastructure and clinic personnel in the best way possible for training, a programme for mathematically optimising the training plan on the basis of the resources available is being developed.

During the course of the various studies at cereneo, the patient's activities and training successes are systematically recorded and documented in a form that can be evaluated. Value is placed on automating the documentation processes, incorporating them into daily life at the clinic and publishing them so that they can also be adopted by other clinics. The data generated forms an important building block for research into improving recovery after a stroke.

ArmeoSenso-Reward

The ArmeoSenso Reward study is a randomised, multi-centric study with the aim of investigating the influence of motivation on the success of therapies undertaken by stroke patients. The sensor-based arm therapy system (ArmeoSenso) is used in two different versions. These versions differ in a few game-specific points but the basic characteristics of the game remain the same. All of the participants train for 15 hours spread across 3 weeks, in addition to a standard therapy. The movements produced by the patients and the scope of the therapy remain comparable between the study groups. Possible differences between the groups in terms of the success of the therapy could be assigned to the motivating aspects of the therapy game.

In order to quantify the success of the therapy, standard clinical assessments (e.g. Fugl-Meyer assessment and Wolf Motor Function Tests) are performed by blind assessors before, after and 3 months after the 3-week training intervention. Furthermore, the movement range of each patient in the study is recorded before and after each therapy session in an automated assessment.

fMRI Reward Assessment

In a dexterity test, performed in a magnetic resonance imaging system (MRI), small amounts of money can be won depending on the performance shown. This leads to the activation of specific reward areas in the brain, which can be measured using functional magnetic resonance imaging (fMRI). In a study with healthy test persons, we were able to show that these activations have a positive influence on the process of learning the dexterity test. These same processes could positively influence the progress of the therapy undertaken by stroke patients. However, the ability of these reward areas to be activated may be reduced in stroke patients.

In the study described here we want to therefore use this dexterity test as an assessment to identify factors (e.g. age, localisation of the stroke, degree of affected movements etc.) that could lead to reduced activations in stroke patients. Furthermore, we also want to use the assessment to clarify with healthy test persons whether the brain activation measured is age-dependent.

Specialist publications

2015

2014

2013

2012

2011

Gonzenbach, Roman R.; Taegtmeyer, Anne B.; Luft, Andreas; Russmann, Stefan (2011): Fluoxetine and motor recovery after ischaemic stroke. In: LANCET NEUROLOGY 10 (6), S. 499–500

Hosp, Jonas A.; Hertler, Benjamin; Atiemo, Clement Osei; Luft, Andreas R. (2011): Dopaminergic modulation of receptive fields in rat sensorimotor cortex. In: NEUROIMAGE 54 (1), S. 154–160. DOI: 10.1016/j.neuroimage.2010.07.029.

Luft AR. The scientific basis of stroke rehabilitation.SWISS ARCHIVES OF NEUROLOGY AND PSYCHIATRY162 (2011): S. 167-168

2010

2009

2008

Luft, Andreas; Macko, Richard; Forrester, Larry; Goldberg, Andrew; Hanley, Daniel F. (2008): Post-stroke exercise rehabilitation: what we know about retraining the motor system and how it may apply to retraining the heart. In: Cleveland Clinic journal of medicine 75 Suppl 2, S. S83-6.

2007

2006

2005

2004

Ettlin, D. A.; Zhang, H.; Lutz, K.; Jarmann, T.; Meier, D.; Gallo, L. M. et al. (2004): Cortical activation resulting from painless vibrotactile dental stimulation measured by functional magnetic resonance imaging (fMRI). In: JOURNAL OF DENTAL RESEARCH 83 (10), S. 757–761.

Luft, A. R.; McCombe-Waller, S.; Whitall, J.; Forrester, L. W.; Macko, R.; Sorkin, J. D. et al. (2004): Repetitive bilateral arm training and motor cortex activation in chronic stroke - A randomized controlled trial. In: JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION 292 (15), S. 1853–1861.

Luft, A. R.; Waller, S.; Whitall, J.; Forrester, L.; Smith, G. V.; Macko, R.; Hanley, D. F. (2004): Bilateral training induces functionally relevant recruitment of contralesional motor cortex in chronic stroke survivors. In: STROKE 35 (6), S. E184-E184.

Partners & cooperations

DynamicDevices

DynamicDevices

Together with DynamicDevices, cereneo tests and helps to develop the Allegro dynamic leg trainer.

ETH Zürich

ETH Zürich

Together with ETH Zürich (D- HEST, Prof. Gassert , Prof. Riener ), cereneo develops sensor technologies to be able to monitor stroke patients during their daily life. Metrics are also developed for measuring therapy effects and being able to inform doctors and patients about the progress of their recovery.

LucerneHealth

LucerneHealth

LucerneHealth is the shared centre for international patients from cereneo, the Lucerne Canton Hospital and the Hirslanden Klinik St. Anna, Lucerne.

Hocoma

Hocoma

Together with Hocoma, cereneo develops new training devices and robots for arms and legs and tests their use in clinical studies.

Johns Hopkins University

Johns Hopkins University

Together with Johns Hopkins University, cereneo performs randomised, clinical studies in the area of arm rehabilitation using new robot training approaches.

Twente University

Twente University

Together with Twente University (Biomedical Signals and Systems, Prof. Dr. ir . Peter Veltink ), cereneo develops sensor and feedback technology for stroke patients.

Testimonial Michael Horacek

"World-class medicine and corresponding treatment require exceptional performance from the team and the best research. And precisely this is found at cereneo. A global network of experts and the specialisation in neurotherapy enable us to achieve the best possible progress for our patients. We also assume that our approach will reduce therapy costs in the long term, as treatments are targeted and more intense."

Michael Horacek, CEO & President of the Administrative Council

Documents for referring physicians

Info text for professionals

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