Erholung im motorischen System nach Hirnschädigung

Zusammenfassung

Mechanismen der Erholung im motorischen System lassen sich unter anderem tierexperimentell untersuchen. Funktionelle Bildgebungsstudien beim Menschen ergänzen diese Befunde und legen nahe, dass das periläsionelle Hirngewebe, das vorübergehend durch eine Ischämie beeinträchtigt worden ist, wieder funktionstragend werden kann. Eine Erhöhung der zerebralen Erregbarkeit tritt aber nicht nur periläsionell, sondern auch in der nicht-betroffenen Hemisphäre auf. Sie ist wahrscheinlich eine weitere Grundlage der postläsionellen Plastizität. Die veränderte zerebrale Erregbarkeit wird auch vom Ort der Schädigung mitbestimmt. Denn umschriebene Hirninfarkte führen zu lokalisationsspezifischen Erregbarkeitsänderungen in räumlich entfernten, aber funktionell verbundenen Hirnarealen. Damit gehen auch unterschiedliche Effekte eines motorischen Trainings auf die zerebrale Erregbarkeit einher. Das verbesserte Verständnis über die Mechanismen der Erholung trägt dazu bei, die rehabilitative Therapie neurowissenschaftlich zu fundieren. Die Entwicklung und Evaluation klinischer motorischer Skalen unterstützt dabei die alltagsnahe Dokumentation von Lähmungsauswirkungen und fördert die Messung von Therapieeffekten. Ein neues Therapiekonzept, dass spezifisch die verschiedenen motorischen Kontrolldefizite bei Lähmungen behandelt (impairment-oriented training – IOT) erwies sich in klinischen Studien als wirksam. Auch pharmakologische Effekte auf Erholung und Trainingseffekte werden geprüft.

Summary

Recovery after brain damage involves various complex mechanisms. The rehabilitation subnet of the German competence net stroke conducts both animal and human studies that promote our understanding of mechanisms of recovery and their modification by therapy. Human brain imaging studies documented the relevance of perilesional brain tissue for functional recovery, an increased cortical excitability in the non-lesioned hemisphere, as well as the modification of changes in cortical excitability and of effects of rehabilitative training by the neuroanatomical location of lesions with specific alterations of excitability in distant functionally connected brain areas. These neuroscience perspectives serve as knowledge base for the development of restorative therapies. The development and evaluation of clinical scales facilitates the clinical documentation of motor deficits and the monitoring of therapeutic effects. Supportive evidence has been provided for new therapeutic concepts such as the impairment-oriented training. In addition, possibilities to enhance recovery by pharmacological interventions have been investigated.

Schlüsselwörter

Schlaganfall - MRI - TMS - Plastizität - Assessment - Training

Keywords

Stroke - MRI,TMS - plasticity - assessment - training

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