Kognitive Trainingsverfahren bei unilateralem Neglekt

Zusammenfassung

Patienten mit einem Schlaganfall der rechten Hirnhälfte leiden häufig unter einem unilateralen Neglekt. Diese Aufmerksamkeitsstörung führt zu einer Vernachlässigung der linken Raum- oder Körperhälfte. Daraus resultieren eine schwere Beeinträchtigung bei alltäglichen Verrichtungen und eine erschwerte Schlaganfall-Rehabilitation. Trotz vielversprechender kognitiver Therapieansätze gibt es bis heute kaum etablierte Therapieverfahren für den Neglekt. Dies ist vor allem der Kurzlebigkeit der Effekte, der eingeschränkten Anwendbarkeit in der breiten Patientenversorgung und fehlenden Übertragbarkeit im Sinne einer funktionellen Verbesserung der Patienten bei den Aktivitäten des täglichen Lebens geschuldet. Diese Arbeit gibt eine Übersicht über die verschiedenen kognitiven Therapieansätze zur Behandlung des Neglekts. Dabei werden die Anwendung, Vor- und Nachteile sowie die Evidenz bezüglich klinischer Effektgrößen kritisch beleuchtet.

Abstract

Patients with a right hemisphere stroke often suffer from a cognitive disorder called neglect. This leads to a severe attentional deficit for the left side of space. Due to the resulting impairments in the activities of daily living, this syndrome represents a major negative prognostic factor for the clinical outcome of stroke patients. Despite promising therapeutic attempts, there is no established and widely accepted cognitive therapy to alleviate or cure neglect. This may be due to the transient nature of therapeutic effects, limited applicability in wide medical practice, and a lack of clear functional improvement of the patients in everyday activities. This article reviews different cognitive interventions to treat neglect with a special focus on advantages and disadvantages as well as evidence for clinically relevant effects of the individual therapies.

Schlüsselwörter

Neglekt - kognitive Therapie - Schlaganfall - instruierende Verfahren - stimulierende Verfahren

Key words

neglect - cognitive therapy - stroke - top-down approaches - bottom-up approaches

• Literatur

• 1 Ward A, Payne KA, Caro JJ et al. Care needs and economic consequences after acute ischemic stroke: the Erlangen Stroke Project. Eur J Neurol 2005; 12: 264-267
• 2 Bowen A, McKenna K, Tallis RC. Reasons for variability in the reported rate of occurrence of unilateral spatial neglect after stroke. Stroke 1999; 30: 1196-1202
• 3 Parton A, Malhotra P, Husain M. Hemispatial neglect. J Neurol Neurosurg Psychiatry 2004; 75: 13-21
• 4 Bisiach E, Luzzatti C. Unilateral neglect of representational space. Cortex 1978; 14: 129-133
• 5 Kinsbourne M. A model for the mechanism of unilateral neglect of space. Trans Am Neurol Assoc 1970; 95: 143-146
• 6 Bowen A, Hazelton C, Pollock A et al. Cognitive rehabilitation for spatial neglect following stroke. Cochrane Database Syst Rev 2013; 7 CD003586
• 7 Antonucci G, Guariglia C, Judica A et al. Effectiveness of neglect rehabilitation in a randomized group study. J Clin Exp Neuropsychol 1995; 17: 383-389
• 8 Kim YM, Chun MH, Yun GJ et al. The effect of virtual reality training on unilateral spatial neglect in stroke patients. Ann Rehabil Med 2011; 35: 309-315
• 9 Katz N, Ring H, Naveh Y et al. Interactive virtual environment training for safe street crossing of right hemisphere stroke patients with unilateral spatial neglect. Disabil Rehabil 2005; 27: 1235-1243
• 10 Beis JM, Andre JM, Baumgarten A et al. Eye patching in unilateral spatial neglect: efficacy of two methods. Arch Phys Med Rehabil 1999; 80: 71-76
• 11 Rossetti Y, Rode G, Pisella L et al. Prism adaptation to a rightward optical deviation rehabilitates left hemispatial neglect. Nature 1998; 395: 166-169
• 12 Kerkhoff G, Schenk T. Rehabilitation of neglect: an update. Neuropsychologia 2012; 50: 1072-1079
• 13 Pizzamiglio L, Fasotti L, Jehkonen M et al. The use of optokinetic stimulation in rehabilitation of the hemineglect disorder. Cortex 2004; 40: 441-450
• 14 Kerkhoff G, Keller I, Artinger F et al. Recovery from auditory and visual neglect after optokinetic stimulation with pursuit eye movements – transient modulation and enduring treatment effects. Neuropsychologia 2012; 50: 1164-1177
• 15 Schindler I, Kerkhoff G, Karnath H-O et al. Neck muscle vibration induces lasting recovery in spatial neglect. J Neurol Neurosurg Psychiatry 2002; 73: 412-419
• 16 Schmidt L, Keller J, Utz KS et al. Galvanic vestibular stimulation improves arm position sense in spatial neglect: a sham-stimulation-controlled study. Neurorehabil Neural Repair 2013; 27: 497-506
• 17 Priftis K, Passarini L, Pilosio C et al. Visual Scanning Training, Limb Activation Treatment, and Prism Adaptation for Rehabilitating Left Neglect: Who is the Winner?. Front Hum Neurosci 2013; 7: 360
• 18 Thimm M, Fink GR, Küst J et al. Impact of alertness training on spatial neglect: A behavioural and fMRI study. Neuropsychologia 2006; 44: 1230-1246
• 19 Azouvi P. Sensitivity of clinical and behavioural tests of spatial neglect after right hemisphere stroke. J Neurol Neurosurg Psychiatry 2002; 73: 160-166
• 20 Machner B, Mah YH, Gorgoraptis N et al. How reliable is repeated testing for hemispatial neglect? Implications for clinical follow-up and treatment trials. J Neurol Neurosurg Psychiatry 2012; 83: 1032-1034