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Evidenzbasierte Armrehabilitation

Eine systematische Literaturübersicht

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Zusammenfassung

Basierend auch einer systematischen MEDLINE-Recherche und informellen Literaturquellen wurden 40 Referenzen identifiziert, die als systematischer Review, Metaanalyse, randomisierte kontrollierte Studie oder kontrollierte Kohortenstudie klinische Prüfungen übungstherapeutischer oder neuromuskulär elektrisch stimulierender Verfahren bei Patienten mit Armlähmungen nach zerebrovaskulären Insult beinhalten. Die Ergebnisse lassen sich in 3 Bereiche zusammenfassen: Vergleich physiotherapeutischer Schulen, Effekt der Trainingsintensität und spezifische Methoden für Patientensubgruppen. Bis auf das "Motor Relearning Programme", einem aufgabenorientierten Training, fanden sich keine Hinweise auf eine unterschiedliche Wirksamkeit der etablierten physiotherapeutischer Schulen. Eine Steigerung der Trainingsintensität kann die motorische Erholung beschleunigen. Für spezifische Subgruppen von Patienten stehen wirksame spezifische Armrehabilitationsmethoden zur Verfügung: für Patienten mit leichten Defiziten der Fein- und Zielmotorik das Armfähigkeitstraining, für Patienten mit partiellen funktionellen Einschränkungen und gelerntem Nichtgebrauch des betroffenen Armes die "constrained-induced movement therapy" (Taub-Training) und für Patienten mit schwerer Armlähmung und erheblich beeinträchtigter Willkürinnervation repetitive sensomotorische Trainingsverfahren, EMG-Biofeedback, funktionelle Elektrostimulation und Robot-assistierte Trainingsverfahren.

Summary

Based on a systematic MEDLINE search and informal sources, 40 references were identified that evaluate training therapy or neuromuscular electric stimulation for arm paresis after stroke and describe either a systematic review, meta-analysis, randomised controlled trial, or controlled cohort study. The evidence was grouped into three areas of interest: comparison of physiotherapy schools, effects of intensity of training, and efficacy of specific arm rehabilitation techniques. The only physiotherapy school with evidence of superior efficacy was the task-oriented 'motor relearning programme'. Higher intensities of motor rehabilitation can accelerate motor recovery. Various training techniques with demonstrated efficacy are available for specific patient subgroups: arm ability training for mildly affected patients with reduced efficiency of motor control, constrained-induced movement therapy for patients with partial functional deficits and learned nonuse of the affected arm, and repetitive sensorimotor training techniques, EMG-biofeedback, functional electrical stimulation, and robot-assisted training for patients with severe arm paresis.

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Diese Arbeit wurde unterstützt durch das BMBF im Rahmen des Kompetenznetzes "Schlaganfall".

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  1. Abteilung für Neurologische Rehabilitation am UKBF der FU Berlin, Klinik Berlin

    T. Platz

  2. Abteilung für Neurologische Rehabilitation am UKBF der FU Berlin, Klinik Berlin, Kladower Damm 223, 14089, Berlin

    T. Platz

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Platz, T. Evidenzbasierte Armrehabilitation. Nervenarzt 74, 841–849 (2003). https://doi.org/10.1007/s00115-003-1549-7

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