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Systemphysiologisch begründete Therapien bei Zerebralparesen

Laufbandtherapie, „Robotic Medicine“ (Lokomat®) und „Constraint Induced Movement Therapy“ (CIMT)

Movement science and intervention in cerebral palsy

Treadmill training, Robotic Medicine (Lokomat®), and Constraint-Induced Movement Therapy

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Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Der Einsatz bildgebender Verfahren und neurophysiologischer Techniken erlaubt in zunehmendem Maße die Exploration neuroplastischer Veränderungen, wie sie möglicherweise infolge einer Intervention im zentralen Nervensystem (ZNS) auftreten können. Dies wird anhand von Laufbanduntersuchungen zur Pathophysiologie des Ganges, zur robotergestützten Laufbandtherapie (Lokomat®) und für die obere Extremität exemplarisch für die „constraint induced movement therapy“ (CIMT) – Behandlungen, die sich durch Aufgabenspezifität und Zielorientierung auszeichnen – dargestellt. Sowohl auf spinaler als auch auf kortikaler Ebene lassen sich durch die Interventionen hervorgerufene Veränderungen nachweisen und Unterschiede im Ansprechen auf die Therapie in Abhängigkeit des Läsions- und Reorganisationstyps darstellen. Dies belegt, dass eine aufgabenspezifische Plastizität des ZNS bei Patienten mit Zerebralparese vorhanden ist und dass in klinischen Studien systemphysiologische Untersuchungen und Erkenntnisse als Stratifizierung- oder Evaluationsinstrument Berücksichtigung finden sollten.

Abstract

Functional magnetic resonance imaging and neurophysiological techniques allow the investigation of plastic changes that might take place, through therapeutic interventions, within the nervous systems of patients with cerebral palsy. This is outlined using studies dealing with treadmill training/spinal reflex modulation, robotic medicine (Lokomat®), and constraint induced movement therapy. These examples show that plastic changes do occur and that the type of lesion and the reorganisation of the nervous system might have an impact on treatment outcome. These findings underpin the idea that movement science should be an integral consideration when planning clinical studies for patients with cerebral palsy.

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Authors and Affiliations

  1. Abteilung Neuropädiatrie, Entwicklungsneurologie und Sozialpädiatrie, Dr. von Haunersches Kinderspital, München, Deutschland

    S. Berweck & I. Borggraefe

  2. Klinik für Neuropädiatrie und neurologische Rehabilitation, Behandlungszentrum Vogtareuth, Krankenhausstraße 20, 83569, Vogtareuth, Deutschland

    S. Berweck & M. Staudt

  3. Abteilung Neuropädiatrie, Entwicklungsneurologie, Sozialpädiatrisches Zentrum, Universitätsklinik für Kinderheilkunde und Jugendmedizin, Universität Tübingen, Tübingen, Deutschland

    M. Staudt & H. Juenger

  4. Klinik II, Neuropädiatrie und Muskelerkrankungen, Universitätskinderklinik Freiburg, Freiburg, Deutschland

    V. Mall & N. Kuhnke

  5. Klinik für Neurologie und klinische Neurophysiologie, Universitätsklinik Freiburg, Freiburg, Deutschland

    M. Hodapp

Authors
  1. S. Berweck
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  2. M. Staudt
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  3. V. Mall
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  4. M. Hodapp
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  5. I. Borggraefe
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  6. N. Kuhnke
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  7. H. Juenger
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Corresponding author

Correspondence to S. Berweck.

Additional information

Die Forschungsarbeiten zu CIMT wurden durch die Deutsche Forschungsgemeinschaft gefördert (Projektnr. STA 859/1-1, BE 3235/1-1, MA 3306/1-1).

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Berweck, S., Staudt, M., Mall, V. et al. Systemphysiologisch begründete Therapien bei Zerebralparesen. Monatsschr Kinderheilkd 157, 1113–1119 (2009). https://doi.org/10.1007/s00112-009-2037-3

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  • DOI: https://doi.org/10.1007/s00112-009-2037-3

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