Aktivierende Therapien bei Parkinson-Syndromen

Zusammenfassung

Trotz wachsender Möglichkeiten in der Pharmakotherapie und der tiefen Hirnstimulation können bei der Mehrzahl der Parkinson-Patienten im Verlauf wesentliche Funktionen wie Gleichgewicht, Gehen, Sprechen, Schlucken und Kognition langfristig nur unzureichend gebessert werden. Den aktivierenden Therapien wie Physio-, Sprech-, Schluck- und Ergotherapie kommt hierbei eine zunehmen de Rolle zu. Der Empfehlungsgrad in den S3-Leitlinien erreicht für die Haupttherapie-formen Level A (Physiotherapie) und B (Logopädie, Schlucktherapie, Ergotherapie). Für die Physiotherapie finden sich die meisten Studien. Neue Ansätze mit Krafttraining, Tanzen, Tai Chi sowie gerätegestützte Ansätze wie Laufbandtraining kombiniert mit neuen Entwicklungen wie virtueller Realität und Spielkonsolen („Exergaming“) weisen eine gute Studienevidenz auf. Die S3-Leitlinie der DGN fordert für alle Patienten in allen Stadien Zugang zu einer zeitlich ausreichenden Physiotherapie. Dieser CME Artikel fasst den Stand der aktivierenden Therapien in der Langzeitversorgung von Parkinson-Patienten zusammen.

Summary

Despite advances in pharmacotherapy and deep brain stimulation most patients with Parkinson’s disease (PD) experience impairments in balance, gait, speech, voice, swallowing and cognition. Non-pharmacological (“Activating”) therapies such as physiotherapy, occupational, swallowing, voice and speech therapy play an important role in alleviating these symptoms. The recommendation level in the German guidelines is the highest for physiotherapy, for occupational and speech therapy it is second highest. Most trials have been performed in physiotherapy. New approaches with progressive resistance training, weight lifting, dance, Tai chi, thread mills combined with virtual reality and exergaming show good evidence in randomised trials. The German S3 guidelines demand that all PD patients in all stages have access to sufficient time resources of physiotherapy. This CME article summarises the role of activating interventions in the long term care of PD patients.

Schlüsselwörter

Parkinson-Syndrome - Physiotherapie - Ergotherapie - Schluck- - Stimm- und Sprechtherapie - Cues - Freezing

Keywords

Parkinson’s disease - physiotherapy - occupational - swallowing - voice and speech therapy - cues - freezing

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