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DOI: 10.1055/s-0044-100488
Physio- und Ergotherapie in der Akut-Neurologie
Physiotherapy and Occupational Therapy in Acute NeurologyPublication History
Publication Date:
05 April 2018 (online)
![](https://www.thieme-connect.de/media/aktneu/201806/lookinside/thumbnails/177_10-1055-s-0044-100488-1.jpg)
Zusammenfassung
Ein integraler Bestandteil der Behandlung neurologischer Patienten ist die Therapie von Funktionsstörungen, die durch neurologische Krankheiten wie z. B. einen Schlaganfall hervorgerufen werden. Das Therapieziel der Physiotherapie besteht darin, bettlägerige Patienten durch aktive Bewegungs- und Gleichgewichtsübungen wieder zu mobilisieren und im Zusammenwirken mit ergotherapeutischen Übungsbehandlungen in die Lage zu versetzen, Verrichtungen alltagrelevanter Tätigkeiten möglichst selbstständig wieder ausführen zu können. Darüber hinaus wird durch multimodale aktiv-assistive Übungen sekundären Versteifungen bewegungseingeschränkter Gliedmaßen entgegengewirkt. Grundlage dieser Behandlungen sind neurophysiologisch basierte Modellvorstellungen über die postläsionelle Plastizität des Gehirns. Es wurden Skalen entwickelt, mit denen neurologische Funktionsstörungen und deren Rückbildung parametrisch und untersucherunabhängig erfasst werden können. Damit kann der Funktionszustand der Patienten dokumentiert und zwischen Behandlungseinrichtungen kommuniziert werden. Außerdem kann so die Effektivität physio- und ergotherapeutischer Maßnahmen in der Akut-Neurologie überprüft werden.
Abstract
Therapy of neurological patients comprises beyond medical treatment the treatment of functional deficits which result from a neurological disease such as stroke. Physiotherapy aims at enabling bedridden neurological patients to become mobile again using training of movement and coordination. In cooperation with occupational therapy patients are trained to become able to perform actions of daily living again. In addition, multimodal activating/assisting exercises are mandatory to counteract the deficit-related development of joint contractions. The rational for these exercises are neurophysiological findings about postlesional cerebral plasticity. Moreover, parametric scales have been developed to assess neurological disturbances and to monitor their restitution in an observer-independent fashion. This allows communication across institutions and to assess the efficacy of physiotherapy and occupational therapy.
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Literatur
- 1 Nelles G. Rehabilitation von sensomotorischen Störungen. AWMF Leitlinien; 2012. http://www.awmf.org/leitlinien/detail/ll/030-123.html
- 2 Bütefisch CM, Hummelsheim H, Denzler P. et al. Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand. J Neurol Sci 1995; 130: 59-68
- 3 Hummelsheim H. Rationales for improving motor function. Curr Opin Neurol 1995; 12: 697-701
- 4 Platz T, van Kaick S, Mehrholz J. et al. Best conventional therapy versus modular impairment-oriented training for arm paresis after stroke: a single-blind, multicenter randomized controlled trial. Neurorehabil Neural Repair 2009; 23: 706-716
- 5 Thaut MH, McIntosh GC, Hoemberg V. Neurobiological foundations of neurologic music therapy: rhythmic entrainment and the motor system. Front Psychol 2015; 5: 1185
- 6 Mudie MH, Matyas TA. Responses of the densely hemiplegic upper extremity to bilateral training. Neurorehabil Neural Repair 2001; 15: 129-140
- 7 Simmons L, Sharma N, Baron JC. et al. Motor imagery to enhance recovery after subcortical stroke: who might benefit, daily dose, and potential effects. Neurorehabil Neural Repair 2008; 22: 458-467
- 8 Rothgangel AS, Braun SM, Beurkens AJ. et al. The clinical aspects of mirror therapy in rehabilitation: A systematic review. Int J Rehab Res 2011; 34: 1-13
- 9 Dohle C, Püllen J, Nakaten A. et al. Mirror therapy promotes recovery from severe hemiparesis: a randomized controlled trial. Neurorehabil Neural Repair 2009; 23: 209-217
- 10 Seitz RJ, Matyas TA, Carey LM. Neural plasticity as a basis for motor learning and neurorehabilitation. Brain Impairment 2008; 9: 103-113
- 11 Cramer SC. Repairing the human brain after stroke: I. Mechanisms of spontaneous recovery. Ann Neurol 2008; 63: 272-287
- 12 Cramer SC. Repairing the human brain after stroke: II. Restorative therapies. Ann Neurol 2008; 63: 549-560
- 13 Seitz RJ. Neurology in Europe. In: Runehov ALC, Oviedo L, Azari NP. eds. Encyclopedia of sciences and religions. Springer Reference; 2013. Vol 3: 1489-1493
- 14 G-DRG System. Institut für Entgeltsystem im Krankenhaus; 2017 http://www.g-drg.de/
- 15 Field MJ, Lohr KN. Guidelines for Clinical Practice: from development to use. Washington DC: National Academic Press; 1992
- 16 Hendriks HJM, Van Ettekoven H, Van der Wees PJ. et al. Eindverslag van het project centrale richtlijnen in de fysiotherapie. Deel 1: Achtergronden en evaluatie van het project [Final Report of the National Guidelines on Physiotherapy Project. Part 1: Backgrounds and Evaluation of the Project]. Amersfoort; Utrecht: Koninklijk Nederlands Genootschap Voor Fysiotherapie, Nederlands Paramedisch Instituut, Kwaliteitsinstituut Voor Gezondheidszorg CBO; 1998
- 17 Woolf SH, Grol R, Hutchinson A. et al. Clinical guidelines: potential benefits, limitations, and harms of clinical guidelines. BMJ 1999; 318: 527-530
- 18 Visser D, Elvers H, Oostendorp RAB. Vakbekwaam en wetenschappelijk verantwoord handelen, haalbaar of… [Acting professionally and evidence based, is it achievable or…]. Issue 2001; 2: 2-4
- 19 Grol R. Invoeren van veranderingen in de praktijk [Introducing changes into practice]. 2nd. ed. In: Grol R, Wensing M. editors. Implementatie, effectieve verandering in de patiëntenzorg [Implementation, Effective Changes in Patient Care]. Maarssen: Elsevier gezondheidszorg; 2001: 25-37
- 20 Campbell SM, Braspenning J, Hutchinson A. et al. Research methods used in developing and applying quality indicators in primary care. Qual Saf Health Care 2002; 11: 358-364
- 21 http://www.cochrane.de/de/leitlinien
- 22 Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc 1986; 34: 119-126
- 23 de Morton NA, Davidson M, Keating JL. The de Morton Mobility Index (DEMMI): an essential health index for an ageing world. Health Quality Life Outcomes 2008; 6: 63
- 24 Dohle C, Quintern J, Saal S. et al. ReMoS-Arbeitsgruppe: S2e-Leitlinie Rehabilitation der Mobilität nach Schlaganfall (ReMoS). Neurol Rehabil 2015; 7: 355-494 http://www.dgnr.de/images/pdf/leitlinien/S2e_Leitlinie_Rehabilitation_der_Mobilitaet_nach_Schlaganfall.pdf
- 25 Van Peppen RPS, Kwakkel G, Harmeling-van derWel BC. et al. KNGF Clinical Practice Guideline for physical therapy in patients with stroke. Review of the evidence [Translation 2008]. Ned Tijdschr v Fysioth 2004; 114 (Suppl. 05) 1-78
- 26 Adler J, Malone D. Early mobilization in the intensive care unit: a systematic review. Cardiopulm Phys Ther J 2012; 23: 5-13
- 27 Sommers J, Engelbert RHH, Dettling-Ihnenfeldt D. et al. Physiotherapy in the intensive care unit: an evidence-based, expert driven, practical statement and rehabilitation recommendations. Clin Rehab 2015; 1-13
- 28 Seidel G, Eggers L, Kücken D. et al. Prognosefaktoren in der Frührehabilitation nach schwerem Schlaganfall. Akt Neurol 2016; 43: 541-547
- 29 Peschke D, Schnizer S, Kuhemey A. et al. Physio- and occupational therapy pathways of stroke patients and stroke mortality. Rehabilitation 2014; 53: 224-229
- 30 Bernhardt J, Churilov L, Ellery F. et al. AVERT Collaboration Group. Prespecified dose-response analysis for A Very Early Rehabilitation Trial (AVERT). Neurology 2016; 86: 2138-2145
- 31 Billinger SA, Arena R, Bernhardt J. et al. Physical activity and exercise recommendation for stroke survivors. A statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45: 2532-2553
- 32 Sullivan JE, Corwner BE, Kluding PM. et al. Outcome measures for individuals with stroke: process and recommendations from the American Physical Therapy Association Neurology Section Task Force. Phys Ther 2013; 93: 1383-1396
- 33 Quinn TJ, Paolucci S, Sunnerhagen KS. et al. Evidence-based stroke rehabilitation: an expanded guidance document from the European Stroke Organization (ESO) guidelines for management of ischaemic stroke and transient ischaemic attack 2008. J Rehabil Med 2009; 41: 99-111
- 34 Lang CE, Strube MJ, Bland MD. et al. Dose response of task-specific upper limb training in people at least 6 months poststroke: a phase II, single-blind, randomized, controlled trial. Ann Neurol 2016; 80: 342-354
- 35 Clarke CE, Patel S, Ives N. et al. PD Rehab Collaborative group. Physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson’s disease. A randomized clinical trial. JAMA Neurol 2016; 73: 291-299
- 36 Nielsen G, Stone J, Matthews A. et al. Physiotherapy for functional motor disorders: a consensus recommendation. J Neurol Neurosurg Psychiatr 2015; 86: 1113-1119
- 37 Hesse S. Gait training after stroke: a critical appraisal. Ann Readapt Med Phys 2006; 49: 621-624
- 38 Kwakkel G, Wagenaar RC, Twisk JW. et al. Intensity of leg and arm training after primary middle-cerebral-artery stroke: a randomised trial. Lancet 1999; 354: 191-196
- 39 Cameirão MS, Badia SB, Oller ED. et al. Neurorehabilitation using the virtual reality based Rehabilitation Gaming System: methodology, design, psychometrics, usability and validation. J Neuroeng Rehabil 2010; 7: 48
- 40 Seitz RJ, Kammerzell A, Samartzi M. Monitoring of visuomotor coordination in healthy subjects and patients with stroke and Parkinson’s disease: an application study using the PABLO-device. Int J Neurorehab 2014; 1,2: 1-8
- 41 Seitz RJ, Donnan GA. Recovery potential after acute stroke. Frontiers Neurol 2015; 6: 238
- 42 Floel A, Nagorsen U, Werhahn KJ. et al. Influence of somatosensory input on motor function in patients with chronic stroke. Ann Neurol 2004; 56: 206-212
- 43 Binkofski F, Seitz RJ, Hackländer T. et al. The recovery of motor functions following hemiparetic stroke: a clinical and MR-morphometric study. Cerebrovasc Dis 2001; 11: 273-281
- 44 Matyas TA, Greenewood KM. Visual analysis of single-case time series: effects of variability, serial dependence, and magnitude of intervention effects. J Appl Behav Analysis 1990; 23: 341-351
- 45 Sommers J, Vredeveld T, Lindeboom R. et al. de Morton mobility index is feasible, reliable, and valid in patients with critical illness. Phys Ther 2016; 96: 1658-1666
- 46 Prasad K. The Glasgow Coma Scale: a critical appraisal of its clinimetric properties. J Clin Epidemiol 1996; 49: 755-763
- 47 Lam B, Middleton LE, Masellis M. et al. Criterion and convergent validity of the Montreal cognitive assessment with screening and standardized neuropsychological testing. J Am Geriatr Soc 2013; 61: 2181-2185
- 48 Blackburn M, van Vliet P, Mockett SP. Reliability of measurements obtained with the modified Ashworth scale in the lower extremities of people with stroke. Phys Ther 2002; 82: 25-34
- 49 Lee Y, An S, Lee G. Clinical utility of the modified trunk impairment scale for stroke survivors. Disabil Rehabil 2017; 7: 1-6
- 50 Schlenstedt C, Brombacher S, Hartwigsen G. et al. Comparison of the Fullerton Advanced Balance Scale, Mini-BESTest, and Berg Balance Scale to Predict Falls in Parkinson Disease. Phys Ther 2016; 96: 494-501
- 51 Wolf SL, Catlin PA, Gage K. et al. Establishing the reliability and validity of measurements of walking time using the Emory Functional Ambulation Profile. Phys Ther 1999; 79: 1122-1133
- 52 Goetz CG, Fahn S, Martinez-Martin P. et al. Movement Disorder Society-sponsored revision of the Unified Parkinsonʼs Disease Rating Scale (MDS-UPDRS): Process, format, and clinimetric testing plan. Mov Disord 2007; 22: 41-47
- 53 Doig E, Fleming J, Kuipers P. et al. Clinical utility of the combined use of the Canadian Occupational Performance Measure and Goal Attainment Scaling. Am J Occup Ther 2010; 64: 904-914