Evidenzbasierte Verfahren in der motorischen Rehabilitation nach Schlaganfall

J. Liepert

doi:10.1055/s-0031-1299490

Fortschritte der Neurologie · Psychiatrie, Table of Contents

Fortschr Neurol Psychiatr 2012; 80(7): 388-393
DOI: 10.1055/s-0031-1299490

Übersicht

Evidenzbasierte Verfahren in der motorischen Rehabilitation nach Schlaganfall

Evidence-Based Methods in Motor Rehabilitation after Stroke

Authors

J. Liepert

Abstract

Zusammenfassung

In dieser Übersicht werden Therapieansätze für die motorische Rehabilitation nach Schlaganfall dargestellt. Berücksichtigt wurden insbesondere randomisierte, kontrollierte Studien, Metaanalysen und systematische Reviews, vorzugsweise aus den Jahren 2009 – 2011. Zusammenfassend ergibt sich für die Constraint-Induced Movement Therapy und Botulinumtoxin A bei fokaler Spastik bereits eine sehr gute Evidenzlage. Bei anderen Verfahren wie dem Einsatz von Pharmaka (insbesondere Serotonin-Wiederaufnahme-Hemmer und L-Dopa), der Spiegeltherapie, der Nutzung Virtueller Realität, dem Einsatz elektromechanischer Geräte zur Wiederherstellung der Gehfähigkeit und einem gezielten Fitness- und Zirkeltraining bestehen Hinweise für eine überlegene Wirksamkeit. Andere Therapien (z. B. bilaterales Armtraining, Laufbandtherapie, robotergestützte Armtherapie) zeigen entweder keine Überlegenheit oder es fehlen ausreichend große klinische Studien (z. B. repetitive transkranielle Magnetstimulation, Sensibilitätstraining).

Abstract

In this review, treatments for motor rehabilitation after stroke will be presented. In particular, randomised, controlled trials, meta-analyses and systematic reviews, mainly from the years 2009 – 2011, were taken into consideration. In summary, evidence is best for constraint-induced movement therapy and Botulinum toxin type A in patients with focal spasticity. Superiority has been demonstrated for the administration of drugs (serotonin re-uptake inhibitors and L-dopa), mirror therapy, the use of virtual reality, electromechanical devices to restore independent walking, and fitness and circuit training. Other therapies (bilateral arm training, treadmill therapy, robot-assisted arm therapy) did not show superiority. For sensory training and repetitive transcranial magnetic stimulation large clinical studies still need to be done.

Schlüsselwörter

evidenzbasiert - motorische Funktionserholung - Schlaganfall - randomisierte kontrollierte Studien

Key words

evidence-based modalities - motor recovery - stroke - randomised controlled trial

Full Text

References

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