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DOI: 10.1055/a-1400-0401
Internationale Studienergebnisse
Schlaganfall – Spiegeltherapie bei Schulter-Hand-Syndrom einsetzen
Das Schulter-Hand-Syndrom (SHS) ist eine chronische Erkrankung mit Schmerzen, Schwellung, vasomotorischer Instabilität und motorischen Beeinträchtigungen. Sie tritt nach Schlaganfall, Extremitätentrauma oder unbekannter Ätiologie auf [1], [2]. Bisher ist nicht untersucht, wie ein Ödemmanagement Schmerzen reduzieren und die Funktion verbessern kann [3]–[5].
Diese Lücke schließen nun indische Forscher. Sie teilten 38 Patienten mit SHS nach Schlaganfall randomisiert in zwei Gruppen ein. Alle erhielten ein 4-wöchiges Schlaganfall-Rehaprogramm – 30 min täglich, 5 Tage pro Woche. Die Übungen bestanden aus beidseitiger rhythmischer Flexion und Extension der Schulter und des Ellenbogens, Unterarmsupination und -pronation, Handgelenkflexion und -extension, Fingerflexion und -extension, Auffächern der Hand, Finger- und Daumenabduktion, Faust machen und loslassen, Greifen von Gegenständen, Einzelfingerbewegung und Daumenopposition.
Die Kontrollgruppe durfte beide Gliedmaßen sehen. Die Interventionsgruppe nutzte hingegen einen Spiegel, der in der Sagittalebene vor ihnen stand. Der betroffene Arm wurde nicht sichtbar hinter, der nicht betroffene Arm vor dem Spiegel gehalten. Outcomes waren der Umfang des Ödems, die Numerische Schmerzskala und der funktionelle Status via FIM (Functional Independence Measure Score).
Nach der Intervention hatten sich beide Gruppen statistisch signifikant (p < 0,05) in allen Outcomes verbessert. Jedoch verbesserte sich die Interventionsgruppe statistisch signifikanter gegenüber der Kontrollgruppe (p < 0,05). Die mittleren Gruppenunterschiede betrugen 1,40 cm für die Ödemmessung, 0,87 für die Numerische Schmerzskala und 12,2 für den FIM Score. Die Verbesserungen hielten bis zur 2-wöchigen Nachuntersuchung an.
Kommentiert von Physio Meets Science
Fazit für die Praxis
Die Ergebnisse zeigen, dass Spiegeltherapie effektiv Schmerzen reduziert und funktionelle Aktivitäten verbessert. Noch deutlicher zeigt sich die Wirkung in einer Reduktion von Ödemen.
Klinisch betrachtet könnte es sein, dass die Patienten durch die Verringerung des Ödems und die Schmerzreduktion mehr Vertrauen in die obere Extremität haben und diese öfter funktionell in den Alltag miteinbeziehen.
PMS
Physiother Res Int 2021; doi:10.1002/pri.1902
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Publication History
Article published online:
14 April 2021
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