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neuroreha 2015; 07(03): 112-118
DOI: 10.1055/s-0035-1564287
Schwerpunkt Frühmobilisation
Georg Thieme Verlag KG Stuttgart · New York

Erste Ergebnisse der GymNAST-Studie

Jan Mehrholz
1   Private Europäische Medizinische Akademie der Klinik Bavaria in Kreischa GmbH, An der Wolfsschlucht 1–2; 01731 Kreischa
,
Simone Thomas
› Author Affiliations
Further Information

Publication History

Publication Date:
10 September 2015 (online)

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Zusammenfassung

Lang andauernde intensivmedizinische Behandlung verursacht häufig eine Schwäche der Muskulatur. Betroffen sind sowohl die Extremitäten als auch die Atmung. Die Beatmungsentwöhnung ist erschwert, die Mortalität steigt. Eine Studie hat nun den Versuch unternommen, die Dauer der Intensivbehandlung zu bestimmen und Prädiktoren für Alltagsbewegungen zu entwickeln, um Therapien entsprechend anpassen zu können.

 

  • Literatur

  • 1 Ambrosino N, Janah N, Vagheggini G. Physiotherapy in critically ill patients. Rev Port Pneumol 2011; 6: 283-288
    Google Scholar
  • 2 Annweiler C, Schott AM, Abellan van Kan G et al. The Five-Times-Sit-to-Stand test, a marker of global cognitive functioning among community-dwelling older women. J Nutr Health Aging 2011; 4: 271-276
    Google Scholar
  • 3 Behrman AL, Light KE, Flynn SM et al. Is the functional reach test useful for identifying falls risk among individuals with Parkinson‘s disease?. Arch Phys Med Rehabil 2002; 4: 538-542
    Google Scholar
  • 4 De Jonghe B, Sharshar T, Lefaucheur JP et al. Paresis acquired in the intensive care unit: A prospective multicenter study. JAMA 2002; 22: 2859-2856
    Google Scholar
  • 5 De Jonghe B, Lacherade JC, Sharshar T et al. Intensive care unit-acquired weakness: Risk factors and prevention. Crit Care Med 2009; 10 (Suppl): S309-S315
    Google Scholar
  • 6 De Letter MA, van Doorn PA, Savelkoul HF et al. Critical illness polyneuropathy and myopathy (CIPNM): Evidence for local immune activation by cytokine-expression in the muscle tissue. J Neuroimmunol 2000; 1–2: 206-213
    Google Scholar
  • 7 Denehy L, de Morton NA, Skinner EH et al. A physical function test for use in the intensive care unit: Validity, responsiveness, and predictive utility of the physical function ICU test (scored). Phys Ther 2013; 12: 1636-1645
    Google Scholar
  • 8 Duncan PW, Weiner DK, Chandler J et al. Functional reach: A new clinical measure of balance. J Gerontol 1990; 6: M192-M197
    Google Scholar
  • 9 Duncan PW, Studenski S, Chandler J et al. Functional reach: Predictive validity in a sample of elderly male veterans. J Gerontol 1992; 3: M93-M98
    Google Scholar
  • 10 Ely EW, Inouye SK, Bernard GR et al. Delirium in mechanically ventilated patients: Validity and reliability of the confusion assessment method for the intensive care unit (CAM-ICU). JAMA 2001; 21: 2703-2710
    Google Scholar
  • 11 Ely EW, Truman B, Shintani A et al. Monitoring sedation status over time in ICU patients: Reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA 2003; 22: 2983-2991
    Google Scholar
  • 12 Ely EW, Shintani A, Truman B et al. Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit. JAMA 2004; 14: 1753-1762
    Google Scholar
  • 13 Fenzi F, Latronico N, Refatti N et al. Enhanced expression of E-selectin on the vascular endothelium of peripheral nerve in critically ill patients with neuromuscular disorders. Acta Neuropathol 2003; 1: 75-82
    Google Scholar
  • 14 Gill DJ, Freshman A, Blender JA et al. The Montreal cognitive assessment as a screening tool for cognitive impairment in Parkinson‘s disease. Mov Disord 2008; 7: 1043-1046
    Google Scholar
  • 15 Han JH, Eden S, Shintani A et al. Delirium in older emergency department patients is an independent predictor of hospital length of stay. Acad Emerg Med 2011; 5: 451-457
    Google Scholar
  • 16 Helliwell TR, Coakley JH, Wagenmakers AJ et al. Necrotizing myopathy in critically-ill patients. J Pathol 1991; 4: 307-314
    Google Scholar
  • 17 Hermans G, Clerckx B, Vanhullebusch T et al. Interobserver agreement of Medical Research Council sum-score and handgrip strength in the intensive care unit. Muscle Nerve 2012; 1: 18-25
    Google Scholar
  • 18 Holden MK, Gill KM, Magliozzi MR et al. Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness. Phys Ther 1984; 1: 35-40
    Google Scholar
  • 19 Hough CL, Lieu BK, Caldwell ES. Manual muscle strength testing of critically ill patients: Feasibility and interobserver agreement. Crit Care 2011; 1: R43
    Google Scholar
  • 20 Kleyweg RP, van der Meche FG, Schmitz PI. Interobserver agreement in the assessment of muscle strength and functional abilities in Guillain-Barre syndrome. Muscle Nerve 1991; 11: 1103-1109
    Google Scholar
  • 21 Lang CH, Frost RA, Vary TC. Regulation of muscle protein synthesis during sepsis and inflammation. Am J Physiol Endocrinol Metab 2007; 2: E453-E459
    Google Scholar
  • 22 Latronico N, Shehu I, Seghelini E. Neuromuscular sequelae of critical illness. Curr Opin Crit Care 2005; 4: 381-390
    Google Scholar
  • 23 Lee JJ, Waak K. Grosse-Sundrup et al. Global muscle strength but not grip strength predicts mortality and length of stay in a general population in a surgical intensive care unit. Phys Ther 2012; 12: 1546-1555
    Google Scholar
  • 24 Lynch SM, Leahy P, Barker SP. Reliability of measurements obtained with a modified functional reach test in subjects with spinal cord injury. Phys Ther 1998; 2: 128-133
    Google Scholar
  • 25 Macht M, Wimbish T, Clark BJ et al. Postextubation dysphagia is persistent and associated with poor outcomes in survivors of critical illness. Crit Care 2011; 5: R23
    Google Scholar
  • 26 Mathiowetz V, Weber K, Volland G et al. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am 1984; 2: 222-226
    Google Scholar
  • 27 Mathiowetz V, Kashman N, Volland G et al. Grip and pinch strength: Normative data for adults. Arch Phys Med Rehabil 1985; 2 69–67
    Google Scholar
  • 28 Mehrholz J, Wagner K, Rutte K et al. Predictive validity and responsiveness of the functional ambulation category in hemiparetic patients after stroke. Arch Phys Med Rehabil 2007; 10: 1314-1319
    Google Scholar
  • 29 Mehrholz J, Pohl M. Assessments bei einem auf ITS erworbenen Schwächesyndrom. Neuroreha 2013; 1: 26-31
    Article in Thieme ConnectGoogle Scholar
  • 30 Mehrholz J, Mückel S, Oehmichen F et al. The General Weakness Syndrome Therapy (GymNAST) study: Protocol for a cohort study on recovery on walking function. BMJ Open 2014; 10 e006168
    Google Scholar
  • 31 Mehrholz J, Pohl M, Burridge J et al. Physical rehabilitation for critical illness myopathy and neuropathy [full review]. Cochrane Database of Systematic Reviews 2015; 3 Art. No.: CD010942
    Google Scholar
  • 32 Mourey F, Grishin A, d‘Athis P et al. Standing up from a chair as a dynamic equilibrium task: A comparison between young and elderly subjects. J Gerontol A Biol Sci Med Sci 2000; 9: B425-B431
    Google Scholar
  • 33 Mückel S, Mehrholz K, Pohl M et al. Rehabilitation nach Critical-Illness-Polyneuropathie und -Myopathie. Klinische Prädiktoren für Erreichen der Gehfähigkeit. Erste Ergebnisse der GymNAST-Studie. Neurol & Rehab 2013; 19: 353
    Google Scholar
  • 34 Nasreddine ZS, Phillips NA, Bedirian V et al. The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment. J Am Geriatr Soc 2005; 4: 695-699
    Google Scholar
  • 35 Nazem S, Siderowf AD, Duda JE et al. Montreal cognitive assessment performance in patients with Parkinson‘s disease with „normal“ global cognition according to mini-mental state examination score. J Am Geriatr Soc 2009; 2: 304-308
    Google Scholar
  • 36 Neto AS, Nassar AP, Cardoso SO et al. Delirium screening in critically ill patients: A systematic review and meta-analysis. Crit Care Med 2012; 6: 1946-1951
    Google Scholar
  • 37 Newton RA. Validity of the multi-directional reach test: A practical measure for limits of stability in older adults. J Gerontol A Biol Sci Med Sci 2001; 4: M248-M252
    Google Scholar
  • 38 Nordon-Craft A, Moss M, Quan D et al. Intensive care unit-acquired weakness: Implications for physical therapist management. Phys Ther 2012; 12: 1494-1506
    Google Scholar
  • 39 Oehmichen F, Ketter G, Mertl-Rotzer M et al. Weaning from prolonged mechanical ventilation in neurological weaning units: An evaluation of the German Working Group for early Neurorehabilitation. Nervenarzt 2012; 10: 1300-1307
    Google Scholar
  • 40 Pandharipande PP, Girard TD, Jackson JC et al. Long-term cognitive impairment after critical illness. N Engl J Med 2013; 14: 1306-1316
    Google Scholar
  • 41 Paternostro-Sluga T, Grim-Stieger M, Posch M et al. Reliability and validity of the Medical Research Council (MRC) scale and a modified scale for testing muscle strength in patients with radial palsy. J Rehabil Med 2008; 8: 665-671
    Google Scholar
  • 42 Pohl M, Mehrholz J. Begriffsbestimmung: Critical-Illness-Polyneuropathie und Critical-Illness-Myopathie. Neuroreha 2013; a 1: 10-16
    Article in Thieme ConnectGoogle Scholar
  • 43 Pohl M, Mehrholz J. Auf einer Intensivstation erworbenes Schwächesyndrom – Langzeitkomplikationen. Neuroreha 2013; b 1: 17-21
    Article in Thieme ConnectGoogle Scholar
  • 44 Schefold J, Bierbrauer J, Weber-Carstens S. Intensive care unit-acquired weakness (ICUAW) and muscle wasting in critically ill patients with severe sepsis and septic shock. Journal of Cachexia Sarcopenia and Muscle 2010; 1: 147-157
    CrossrefGoogle Scholar
  • 45 Sessler CN, Gosnell MS, Grap MJ et al. The Richmond Agitation-Sedation Scale: Validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med 2002; 10: 1338-1344
    Google Scholar
  • 46 Skinner EH, Berney S, Warrillow S et al. Development of a physical function outcome measure (PFIT) and a pilot exercise training protocol for use in intensive care. Crit Care Resusc 2009; 2: 110-115
    Google Scholar
  • 47 Smith T, Gildeh N, Holmes C. The Montreal Cognitive Assessment: Validity and utility in a memory clinic setting. Can J Psychiatry 2007; 5: 329-332
    Google Scholar
  • 48 Spitzer AR, Giancarlo T, Maher L et al. Neuromuscular causes of prolonged ventilator dependency. Muscle Nerve 1992; 6: 682-686
    Google Scholar
  • 49 Stevens RD, Dowdy DW, Michaels RK et al. Neuromuscular dysfunction acquired in critical illness: A systematic review. Intensive Care Med 2007; 11: 1876-1879
    Google Scholar
  • 50 Thrush A, Rozek M, Dekerlegand JL. The clinical utility of the functional status score for the intensive care unit (FSS-ICU) at a long-term acute care hospital: A prospective cohort study. Phys Ther 2012; 12: 1536-1545
    Google Scholar
  • 51 Tipping CJ, Young PJ, Romero L et al. A systematic review of measurements of physical function in critically ill adults. Crit Care Resusc 2012; 4: 302-311
    Google Scholar
  • 52 Visser LH. Critical illness polyneuropathy and myopathy: Clinical features, risk factors and prognosis. Eur J Neurol 2006; 11: 1203-1212
    Google Scholar
  • 53 Wijdicks EF, Litchy WJ, Harrison BA et al. The clinical spectrum of critical illness polyneuropathy. Mayo Clin Proc 1994; 10: 955-959
    Google Scholar
  • 54 Zhao J, Brault JJ, Schild A et al. FoxO3 coordinately activates protein degradation by the autophagic/lysosomal and proteasomal pathways in atrophying muscle cells. Cell Metab 2007; 6: 472-483
    CrossrefGoogle Scholar
  • 55 Zochodne DW, Bolton CF, Wells GA et al. Critical illness polyneuropathy. A complication of sepsis and multiple organ failure. Brain 1987; 819-841
    Google Scholar