Orthesengestütztes Eigentraining im häuslichen Umfeld führt zu motorisch-funktioneller Verbesserung bei einem Patienten nach Schlaganfall

Zusammenfassung

Hintergrund: Für mittelgradig bis schwer betroffene Patienten nach Schlaganfall sind die Möglichkeiten der Rehabilitationsmaßnahmen limitiert. Bisherige Evidenz spricht dafür, dass repetitives, aufgabenspezifisches Training zu motorischen Verbesserungen der Hand- und Armfunktion bei chronischen Schlaganfallpatienten führt.

Ziel: Der Fallbericht beschreibt die nachhaltige Verbesserung der motorischen Funktion der oberen Extremität infolge eines orthesengestützten Eigentrainings bei einem 54-jährigen Patienten mit spastischer Hemiparese rechts zu Beginn des Trainings knapp 4 Jahre nach Schlaganfall.

Methode: Die Intervention beinhaltete ein 5-tägiges Intensivtraining à 3 Stunden unter therapeutischer Anleitung, gefolgt von einem täglichen selbstständig durchgeführten Eigentraining im häuslichen Umfeld und begleitet von regelmäßiger Supervision und Evaluation (Fugl-Meyer-Test, Action Research Arm Test, Ashworth-Skala, isometrische Griffkraft, Stroke Impact Skala) über 9 Monate sowie 2-maliger Injektion mit Botulinumtoxin.

Ergebnisse: Der Patient zeigte über die 9 Monate eine deutliche Verbesserung der motorischen Funktion und schätzte die negativen Auswirkungen des Schlaganfalls auf seine Lebensqualität nach dem Eigentraining als prägnanter ein.

Schlussfolgerung: Die Ergebnisse deuten daraufhin, dass ein systematisches, therapeutisch supervidiertes orthesengestütztes Eigentraining die aktive Trainingszeit erhöhen und zu nachhaltigen motorisch-funktionellen Verbesserungen bei Patienten im chronischen Stadium führen kann.

Abstract

Background: Therapeutic interventions are limited for patients with moderate to severe impairment of upper-limb motor function after stroke. Current evidence suggests repetitive, task-oriented training to improve motor hand and arm function in chronic stroke patients.

Objective: This case study describes sustained improvement of upper extremities’ motor function resulting from orthotic-aided self-administered exercise in a 54-year old patient with right-sided spastic hemiparesis at the beginning of the training barely 4 years after stroke.

Method: Treatment included a 3 hours intensive tutorial training followed by daily independent self-administered orthotic-aided home exercise and accompanied by regular supervision and evaluation (Fugl-Meyer Test, Action Research Arm Test, Ashworth Spasticity Scale, Grip and Pinch Force, Stroke Impact Scale) during 6 months as wells as 2 botulinumtoxin injections.

Results: Over the period of 9 months the patient showed distinct improvement of motor function and after the self-administered training reassessed the negative stroke impacts on his quality of life more coherently.

Conclusion: The results point out that a systematic therapeutically-supervised orthotic-aided home exercise programme may increase the active practice period and result in distinct motor function improvement in chronic stroke patients.

Schlüsselwörter

Schlaganfall - orthesengestütztes Training - obere Extremität - motorische Verbesserung - Rehabilitation - Eigentraining

Key words

stroke - orthotic-aided exercise - upper extremity - motor improvement - rehabilitation - self-administered training

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