Was können wir aus bildgebenden Verfahren für die motorische Rehabilitation lernen?

Zusammenfassung

Einzelbefunde aus den Reorganisationsstudien nach Hirninfarkt machen es schwierig, ein einheitliches und einfaches Reorganisationskonzept zu erkennen. Querschnittsstudien zeigen eine vermehrte Aktivierung in einem bilateralen Netzwerk mit den homologen, kontraläsionalen Strukturen und einer vermehrten Aktivierung um den Infarkt herum. Die Reorganisation läuft phasenhaft ab mit einer frühen Aktivitätsminderung (Diaschisis), gefolgt von einer Hochregulation und Überaktivierung und einer späten Rückkehr zum Ausgangsniveau. Die Phasen sind in der betroffenen und nicht betroffenen Hemisphäre zeitlich versetzt. Studien zum motorischen Lernen zeigen mindestens zwei Phasen. Interessant werden funktionelle bildgebende Verfahren bei der Multiplen Sklerose, da hier schon sehr frühzeitig Reorganisationsphänomene dargestellt werden können.

Summary

A variety of functional imaging studies conducted with post stroke patients – sometimes with contradictory results– are cited and discussed without providing clear and straight forward concepts regarding of reorganization after stroke. Studies concerning motor learning are of paramount importance for rehabilitation although there are incomplete conclusions from research on physiological motor learning. Recent functional imaging studies on multiple sclerosis are of potential interest. They possibly indicate reorganization at an early stage even before structural lesions can be recognized.

Schlüsselwörter

Plastizität - motorisches Lernen - Rehabilitation - Reorganisation - Hirninfarkt - Multiple Sklerose

Keywords

Plasticity - motoric learning - rehabilitation - reorganization - stroke - multiple sclerosis

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