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Intervallrehabilitation mit häuslichem Training bei Kindern mit Zerebralparese

Interval-rehabilitation and home-based training for children with cerebral palsy

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Zusammenfassung

Hintergrund

Ziel der Rehabilitation von Patienten mit Zerebralparese (CP) ist es, durch Maßnahmen wie Physiotherapie die motorischen Funktionen zu verbessern. Das Angebot ist groß, die Evidenz für die einzelnen Behandlungskonzepte jedoch trotz mehrerer Studien nicht zufriedenstellend. „Auf die Beine“, das Kölner Modell der Intervallrehabilitation, kombiniert kurze intensive stationäre Phasen mit 6 Monaten häuslichem Training unter Verwendung der seitenalternierenden Ganzkörpervibration. Die Ergebnisse der motorischen Fähigkeiten nach der aktiven Phase und nach weiteren 6 Monaten Follow-up werden vorgestellt.

Methoden

Die motorischen Fähigkeiten wurden mit dem Gross Motor Function Measure (GMFM) gemessen. Die Auswertung der Daten von 356 Patienten erfolgte mithilfe des GMFM-66-Gesamtscores nach 6 (aktive Phase) und 12 Monaten (6-Monate-Follow-up) bzw. der Zieldimensionen des GMFM-88 nach 6 Monaten.

Ergebnisse

Die Patienten zeigten nach Abschluss des Trainings einen verbesserten GMFM-66-Gesamtscore um 2,9 Punkte (Mittelwert 3,4; p < 0,001) und nochmals eine Verbesserung um 0,2 Punkte (Mittelwert 0,6; p = 0,033) nach dem Follow-up. Bezüglich der Zieldimension A (Liegen und Drehen) verbesserten sie sich um 2,0 % (Mittelwert 3,8; p < 0,001), bezüglich B (Sitzen) um 3,3 % (Mittelwert 5,9; p <0,001), C (Krabbeln und Knien) um 4,8 % (Mittelwert 6,7; p < 0,001), D (Stehen) um 5,1 % (Mittelwert 8,0; p < 0,001) und E (Gehen, Rennen und Springen) um 2,8 % (Mittelwert 4,6; p < 0,001).

Schlussfolgerung

Die Intervallrehabilitation mit häuslichem Training hat einen signifikant positiven Effekt auf die motorischen Fähigkeiten bei Patienten mit CP. Die Verbesserung nach den ersten 6 Monaten blieb auch im Follow-up nach 12 Monaten erhalten.

Abstract

Background

The goal of rehabilitation of children with cerebral palsy (CP) is to reduce sequelae and enhance function. Physiotherapy is a rehabilitative strategy for the treatment of patients with CP, but with little supporting evidence for the different treatment concepts. The Cologne Concept “Auf die Beine” combines interval rehabilitation with short and intensive in-patient stays with 6-month home-based whole body vibration training. In this article, we present gross motor function results after 6 months of training and an additional 6 months of follow-up.

Methods

Gross motor function was assessed with the Gross Motor Function Measure (GMFM). A total of 356 patients were evaluated using the GMFM-66 total score after 6 and 12 months and the GMFM-88 goal dimensions after 6 months.

Results

The GMFM-66 total score improved by 2.9 points (mean 3.35; p < 0.001) after 6 months and by 0.2 points (mean 0.63; p = 0.033) after 6 months of follow-up. Goal dimension A (lying) improved by 2.0 % (mean 3.8; p = 0.001), B (sitting) by 3.3 % (mean 5.9; p < 0.001), C (crawling) by 4.8 % (mean 6.7; p < 0.001), D (standing) by 5.1 % (mean 8.0; p < 0.001), and E (walking) by 2.8 % (median 4.6; p < 0.001).

Conclusion

Interval rehabilitation combined with home-based training has a significant positive effect on gross motor function in patients with CP. The results were also sustained after 6 months of follow-up.

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Interessenkonflikt

Die korrespondierende Autorin weist auf folgende Beziehungen hin: Prof. Dr. E. Schönau ist ärztlicher Leiter und Geschäftsführer der UniReha GmbH. und Dr. I. Duran, C. Stark und Dr. O. Semler sind für die UniReha GmbH tätig. A. Stabrey, I. Kaul, Dr. P. Herkenrath, Dr. S. Waltz und Dr. H. Hollmann geben an, dass kein Interessenskonflikt besteht. Die Firma Novotec Medical GmbH unterstützt Studien der klinischen Forschung an der UniReha GmbH.

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Authors and Affiliations

  1. Klinik und Poliklinik für Kinder- und Jugendmedizin, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    C. Stark MSc., O. Semler, A. Stabrey, P. Herkenrath & E. Schönau

  2. UniReha GmbH Köln, Köln, Deutschland

    C. Stark MSc., I. Duran & E. Schönau

  3. Kinderneurologisches Zentrum, LVR -Klinik Bonn, Bonn, Deutschland

    H. Hollmann

  4. Kinderkrankenhaus Amsterdamer Straße, Kliniken der Stadt Köln gGmbH, Köln, Deutschland

    S. Waltz

  5. Institut für Medizinische Statistik, Informatik und Epidemiologie (IMSIE), Universität zu Köln, Köln, Deutschland

    I. Kaul

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  1. C. Stark MSc.
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  2. O. Semler
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  3. I. Duran
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Correspondence to C. Stark MSc..

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Stark, C., Semler, O., Duran, I. et al. Intervallrehabilitation mit häuslichem Training bei Kindern mit Zerebralparese. Monatsschr Kinderheilkd 161, 625–632 (2013). https://doi.org/10.1007/s00112-013-2910-y

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