[Home-based telerehabilitation after stroke]. / Telerehabilitation nach Schlaganfall im häuslichen Umfeld.

The use of modern information and telecommunication technologies enables telerehabilitation of neurological deficits in the domestic environment. The current state of studies on rehabilitative teletherapy for improvement of motor function and mobility deficits due to stroke is reviewed. Two neurolinguistic proof of concept studies investigating the efficacy of online interactive telespeech therapy are reported, which compared virtual screen to screen interactive telerehabilitation of aphasia after stroke and dysarthrophonia in Parkinson's disease to conventional face to face rehabilitation. The results of the studies indicate that the neurological rehabilitation of motor and communicative deficits in the domestic environment of patients by means of teletherapy is just as efficient as conventional rehabilitation. Under home-based telerehabilitation patient transfer becomes unnecessary. Rehabilitative Teletherapy is a posthospital component of a cross-sector supply chain for patients with handicaps or impairments due to stroke and other neurological diseases.

[Fundus spectrometry in age-related maculopathy]. / Fundusspektrometrie bei altersbezogener Makulopathie.

BACKGROUND: Spectroscopic methods permit the non-invasive detection of fundus pigments by the wavelength-dependent absorption of fluorescence as well as by the fluorescence lifetime. From the relative concentrations of haemoglobin and oxyhaemoglobin, the oxygen saturation can be calculated. The onset of age-related maculopathy might be delayed by a high optical density of xanthophyll. The detection of alterations in fundus autofluorescence points to age-related pathomechanisms (accumulation of lipofuscin, formation of connective tissue). The detection of autofluorescence of redox-pairs of coenzymes results in information about metabolic states at the cellular level, and might make possible an early detection of age-related changes when they are still reversible. METHOD: The evaluation of reflectance spectra, detected by imaging ophthalmo-spectrometry, results in the calculation of oxygen saturation or in the optical density of xanthophyll or of melanin. Fluorescence spectra can be measured also by this technique. For the 2-dimensional determination of the distribution of xanthophyll, a very simple method was developed, requiring fundus illumination by one wavelength only. In the detection of time-resolved autofluorescence, the fluorescence lifetime is used for the determination of endogenous fluorophores. RESULTS: As result of comparing studies between ARM patients and healthy subjects, the consumption of retinal oxygen was increased already in the children of ARM patients. An increasing optical density of xanthophyll was determined after lutein supplementation. Differences in fluorescence lifetime were determined between ARM patients and healthy subjects, but their interpretation requires investigations of cell or of organ model cultures. CONCLUSIONS: The described methods permit in vivo basic investigations of ARM and can be considered as impulses for the development of diagnostic devices.

[On line ophthalmologic education. Live transfers and on demand lectures via Internet]. / Augenärztliche Online-Fortbildung. Live-Ubertragungen und On-demand-Vorträge via Internet.

Continuing medical education for ophthalmologist is important and demanded from the board of ophthalmic organizations. The use of new multimedia possibilities provided by the internet, offers an alternative to acquire the training sessions requested by the board. Aim of the paper is to show the efforts made, to place an internet-based training website for ophthalmologists by transferring live ophthalmology events via the internet. The live-transfers of selected lectures is realized by transferring the original sound compatible to the software "Real-Audio-Player" with an rate of 8000 Hz (encoding-depth 14 bits). By using this software it is possible to follow the lectures live. It includes also 2 live-pictures of 2 digital camcorders to show the appropriate slides from the lecturer. The live broadcasted lectures were afterwards revised and are available at any time as "on-demand lectures" with original sound and slides. Since November 1997, 15 continuing medical education events for ophthalmologists of the University Erlangen-Nürnberg, Germany and from other universities were live broadcasted covering all aspects of phthalmology can be viewed as "on-demand lectures" with original-sound and slides under the internet-addresse http:¿www.onjoph.com/deutsch/live.html. The broadcasted events of workshops were watched via the internet with the appropriate software by 3500 persons, and approximately 5200 persons were listening at least one of the lectures since 1997.

[New avenues of communication for continuous medical education: first experiences of live broadcasting of ophthalmologY congresses via Internet]. / Neue Kommunikationswege in der ärztlichen Fortbildung--Erste Erfahrungen von Live-Ubertragungen augenärztlicher Kongresse im Internet.

BACKGROUND: The usage of the Internet in live-broadcasting ophthalmological lectures might be helpful in the education of eye doctors. The purpose is to report first experiences of a live-broadcasted congress. METHOD: The congress "Autonomic Innervation and Microcirculation of the Eye--Implications in Glaucoma Pathophysiology", held in the Department of Ophthalmology of the University Erlangen-Nürnberg at the 27th January 1999 was live-broadcasted via Internet by the electronic journal "Online Journal of Ophthalmology" (www.onjoph.com). The congress was organized by the "Sonderforschungsbereich 539, Glaukome, einschliesslich PEX" of the University Erlangen-Nürnberg. The original sound of the lectures was digitized by 8000 Hz and coded with 14 bit. Using the free software "Real-Audio-Player" the user could hear the speech of the lecturer in radio quality. Two live-pictures from two digital video cameras and the digitized slides were available at the screen within two frames. Two weeks before all 6576 ophthalmologists in Germany were informed about the event by conventional mail. RESULTS: The live-broadcasted congress was followed by 899 online-participants (899/6576 = 13.6%). 238 of 899 participants were able to hear the original sound. 154 of 6576 (2.3%) ophthalmologists answered by FAX. 18% of the answering eye doctors have followed the congress by Internet. Mainly all (98%) of them were very interested in live-broadcasted lectures or congresses and wanted to be informed about the next lecture or congress broadcasted by means of Internet. The lectures-on demand of this congress with sound and pictures are now available under the address http:/(/)www.onjoph. com/global/livewrk1/Default.htm. CONCLUSION: The major part of eye doctors in Germany seems very interested in live-broadcasted lectures for online-education. In the first national-wide trial 899 of 6576 informed eye doctors followed the congress.

Imaging spectrometry in ophthalmology--principle and applications in microcirculation and in investigation of pigments.

Imaging spectrometry is a new technique that permits simultaneous measurements of reflectance spectra at different locations along a line. Results are three-dimensional images, whose coordinates are location, wavelength, and reflectance. A conventional fundus camera is adapted to a spectrograph and an intensified charge coupled device (CCD) matrix detector system. The spectral resolution of this spectrometer is lower than 2 nm within a spectral range between 395 and 710 nm. The local resolution is lower than 23 microns along a line of 1.5 mm. From an imaging spectrum, the extinction spectrum of blood in vessels can be calculated. Also, in case of a noisy extinction spectrum of blood, its approximation by a model function results in calibration-free measurement of the oxygen saturation. Considering the radiation transport in single fundus layers, the local distribution of the concentration-thickness product of xanthophyll, melanin, and choroidal blood can be calculated.

[Substance analytic studies of the effectiveness of laser coagulation in diabetic retinopathy]. / Substanzanalytische Untersuchungen zur Wirkung der Laserkoagulation bei diabetischer Retinopathie.

An order to optimize photocoagulation in diabetic retinopathy, it is necessary to have objective criteria concerning substance-specific fundus changes like blood, melanin, xanthophyl, cytochrome aa3, and light scattering. By means of fundus reflectometry macular reflectance spectra can be measured and are different in normals and in diabetics before or after treatment. If logarithmic difference spectra are used only pathological alterations or changes caused by the coagulation are demonstrable. These difference spectra can be approximated by a linear model function containing the extinction spectra of the substances mentioned above and a term for light scattering. Spectra deconvolution delivers coefficients, describing differences in the substance concentrations between diabetics before and after treatment and age-matched normals. When we examined these coefficients, we found that neither their behavior in diabetic retinopathy nor their reaction to photocoagulation is unique. Thus, it might be possible to obtain references to patient-specific adapted coagulation by deconvolution of the macular reflectance spectra measured before treatment. Classification of the patients in specific types of reaction, according to the shape of the logarithmic difference spectra or the results of the spectra deconvolution, could be a step in deciding on the success of the therapy on a case-to-case basis.

Spectrometric investigations in ocular hypertension and early stages of primary open angle glaucoma and of low tension glaucoma--multisubstance analysis.

The approximation of logarithmic difference spectra between the reflectance of the normal fundus and the fundus reflectance in different stages of glaucoma is demonstrated by a model. The influences of fundus pigments like oxihemoglobin, melanin, xanthophyll and rhodopsin as well as the intensity and the exponent of the scattered light are optimized. Glaucomatous alterations in the extinction of these pigments and of the scattering parameters are different in the macula, in the papillo-macular bundle and in the parapapillary region temporal to the optic disc. A lack of oxihemoglobin only in the papillo-macular bundle in first relative losses in the visual field function points to a damaged microcirculation in early POAG. In progressive glaucoma the extinction spectrum of xanthophyll is detectable in the papillo-macular bundle. A decreased intensity of the scattered light and an altered scattering exponent are suggestive of a damage in the nerve fiber layer at early stages of glaucoma.