Übende Therapie bei Morbus Parkinson

Zusammenfassung

Die Wirkung übender Therapieverfahren wie Krankengymnastik, Ergotherapie und Logopädie auf die motorischen Störungen bei idiopathischer Parkinson-Erkrankung wurde bisher nur in wenigen, meist relativ kleinen und methodisch oft unzureichenden Studien untersucht. Theoretisch lässt sich aus den der Akinese zugrunde liegenden neurobiologischen Störungen folgern, dass adjuvante Therapieverfahren auf eine Substitution der bei Parkinson-Erkrankung vermindert generierten internalen Steuerungssignale und eine Verbesserung der Integration propriozeptiver Afferenzen ausgerichtet sein sollte. Einige kleinere kontrollierte Studien konnten zeigen, dass die Verwendung unterstützender sensorischer Signale („Cues”), gezieltes Üben von Ausfallschritten, Training des Sprechvolumens und andere spezifisch auf typische motorische Defizite der Parkinson-Erkrankung ausgerichtete Therapieansätze zu messbaren Verbesserungen der motorischen Performance führen. Diese Übersicht gibt einen Überblick über die konzeptionellen und neurophysiologischen Grundlagen adjuvanter Therapie bei Parkinson-Erkrankung und diskutiert die vorhandenen klinischen Studien.

Abstract

The effect of training procedures including physiotherapy, behavioral and speech therapy on motor performance in Parkinson's disease have only been studied in a small number of studies which are often characterised by methodological shortcomings. In theory, the neurobiological background of akinesia suggests that rehabilitative therapy should aim at substituting defective internal cueing and at improving sensory perception. In several controlled trials therapeutic use of sensory cues, training of compensatory steps, speech therapy focussing on voice volume and other strategies adapted to specific demands of motor disturbances in Parkinson's disease have been shown to effectively improve motor performance in a small number of subjects. In this paper conceptual and neurobiological basics of rehabilitative therapy in Parkinson's disease and application of therapeutic strategies in clinical studies will be reviewed.

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