Therapeutische Interventionen bei unilateralem Neglekt und ihre Wirkung auf Alltagstätigkeiten - Ein Review

Zusammenfassung

Einleitung: Unilateraler Neglekt ist ein allgemein anerkannter Prädiktor für schlechte Ergebnisse bei der Schlaganfallrehabilitation. Das Syndrom hat bedeutsame Implikationen für die Ergotherapie, da es sich in einer Beeinträchtigung der Aktivitäten des täglichen Lebens (ADL) manifestiert. Dieser Review stellt die derzeit gängigen therapeutischen Interventionen bei unilateralem Neglekt vor und untersucht, ob eine Reduzierung der ADL-Einschränkungen für Neglekt-Patienten von Vorteil sein kann.

Methoden: Der Literaturreview erfolgte für Veröffentlichungen bis Januar 2007 in den Datenbanken AMED, CINAHL, MEDLINE, PsycINFO, PEDro, OTseeker, Global Health und Cochrane Library. Analysiert wurden Studiendesign, untersuchte Population, Interventionen und ihre Auswirkungen auf Alltagsaktivitäten.

Ergebnisse: 3 RCT und 35 andere Studien (Fall- und Crossover-Studien) wurden identifiziert. 8 Studien zielten auf die Aktivierung der rechten Hemisphäre, wovon 5 Studien Scanning-Training, computerunterstützte Strategien und Prismenadaptation und einige andere Studien 6 weitere Interventionsarten behandelten. Einige therapeutische Strategien führten zu einer Reduzierung der Neglekt-Symptome, die jedoch nur von kurzer Dauer waren. In 7 Studien fanden sich (tendenzielle) Hinweise für eine positive Wirkung auf Alltagsaktivitäten. Bis zum gegenwärtigen Zeitpunkt existieren keine Richtlinien zu empfohlenen Interventionen.

Schlussfolgerung: Bisherige Studien mit verschiedenen Grundannahmen zum unilateralen Neglekt zeigen kaum Evidenz für eine positive Wirkung der Interventionen in Bezug auf Alltagsaktivitäten. Sie weisen methodische Mängel und geringe Stichprobengrößen auf und fokussieren meist auf kognitive Funktionen und nicht auf das Gelingen von Betätigung als Ergebnisparameter.

Abstract

Introduction: Unilateral neglect is a well recognized predictor of poor functional outcome in stroke rehabilitation. The syndrome has important implications for occupational therapy due to its manifestations regarding impaired activities of daily living. This review presents the current therapeutic interventions for unilateral neglect and investigates if there are benefits for neglect subjects in reducing existing limitations in activities of daily living.

Method: A comprehensive literature review was conducted on studies until January 2007 in the databases of AMED, CINAHL, MEDLINE, PsycINFO, PEDro, OTseeker, Global Health, and Cochrane Library. Study designs, population, intervention itself and the effect of the intervention on daily occupations were analysed.

Results: 3 RCT and 35 other studies (case and crossover studies) were identified: 8 studies aimed at activating the right hemisphere, 5 of which focused on scanning training, computer assistive strategies and prism adaptation, and several studies investigated six other methods of intervention. Some therapeutic strategies showed reduced neglect symptoms but only with short lasting benefits. A positive effect on activities of daily living was indicated in 7 studies. No recommended intervention guideline has been developed to date.

Conclusions: Present studies with varying approaches to unilateral neglect show little evidence for the interventions’ positive effects on everyday activities. They have methodological flaws and small samples with tendency to focus on cognitive function rather than successful achievement of occupation.

unilateraler Neglekt - Schlaganfall - Rehabilitation - Ergotherapie

unilateral neglect - stroke - rehabilitation - occupational therapy

Literatur

• 1 American Heart Association .Heart disease and stroke statistics - 2005 update. 22.12.2005 www.americanheart.org/downloadable/heart/ 1105390918119 HDSStats2005Update.pdf>
• 2 Antonucci G, Guariglia C, Judica A. et al . Effectiveness of neglect rehabilitation in a randomized group study.  J Clin Exp Neuropsychol. 1995;  17 282-289
• 3 Beis J M, Andre J M, Baumgarten A. et al . Eye patching in unilateral spatial neglect: efficacy of two methods.  Arch Phys Med Rehabil. 1999;  80 71-76
• 4 Bowen A, Lincoln N B, Dewey M E. Cochrane corner. Spatial neglect: is rehabilitation effective?.  Stroke. 2002;  33 2728-2729
• 5 Bowen A, Lincoln N B, Dewey M E. Cognitive rehabilitation for spatial neglect following stroke.  Cochrane Database Syst Rev. 2002;  2 1-32
• 6 Bowen A, Wenman R. The rehabilitation of unilateral neglect: a review of the evidence.  Rev Clin Gerontol. 2002;  12 357-373
• 7 Brunila T, Lincoln N, Lindell A. et al . Experiences of combined visual training and arm activation in the rehabilitation of unilateral visual neglect: A clinical study.  Neuropsychol Rehabil. 2002;  12 40
• 8 Buxbaum L J. On the right (and left) track: Twenty years of progress in studying hemispatial neglect.  Cogn Neuropsychol. 2006;  23 184-201
• 9 Cappa S F, Benke T, Clarke S. et al . EFNS guidelines on cognitive rehabilitation: report of an EFNS task force.  Eur J Neurol. 2005;  12 665-680
• 10 Capruso D X, Levin H S. Cognitive impairment following closed head injury.  Neurol Clin. 1992;  10 879-893
• 11 Cassidy T P, Lewis S, Gray C S. Recovery from visuospatial neglect in stroke patients.  J Neurol Neurosurg Psychiatry. 1998;  64 555-557
• 12 Cherney L R, Halper A S, Kwasnica C M. et al . Recovery of functional status after right hemisphere stroke: Relationship with unilateral neglect.  Arch Phys Med Rehabil. 2001;  82 322-328
• 13 Cicerone K D, Dahlberg C, Kalmar K. et al . Evidence-based cognitive rehabilitation: Recommendations for clinical practice.  Arch Phys Med Rehabil. 2002;  81 1596-1615
• 14 Cicerone K D, Dahlberg C, Malec J F. et al . Evidence-based cognitive rehabilitation: updated review of the literature from 1998 through 2002.  Arch Phys Med Rehabil. 2005;  86 1681-1692
• 15 Dawson J, Thornton H. Can patients with unilateral neglect following stroke drive electrically powered wheelchairs?.  British Journal of Occupational Therapy. 2003;  66 496-504
• 16 Diller L, Riley E. The behavioural management of neglect. Robertson IH, Marshall JC Unilateral neglect: Clinical and experimental studies Hove; Lawrence Erlbaum 1993
• 17 Eskes G A, Butler B, McDonald A. et al . Limb activation effects in hemispatial neglect.  Arch Phys Med Rehabil. 2003;  84 323-328
• 18 Frassinetti F, Angeli V, Meneghello F. et al . Long-lasting amelioration of visuospatial neglect by prism adaptation.  Brain. 2002;  125 608-623
• 19 Freeman E. Unilateral spatial neglect: new treatment approaches with potential application to occupational therapy.  Am J Occup Ther. 2001;  55 401-408
• 20 Gillen R, Tennen H, McKee T. Unilateral spatial neglect: relation to rehabilitation outcomes in patients with right hemisphere stroke.  Arch Phys Med Rehabil. 2005;  86 763-767
• 21 Harvey M, Hood B, North A. et al . The effects of visuomotor feedback training on the recovery of hemispatial neglect symptoms: assessment of a 2-week and follow-up intervention.  Neuropsychologia. 2003;  41 886-893
• 22 Heilmann K M, Watson R T, Valenstein E. Neglect and related disorders. Heilman KM, Valenstein E Clinical Neuropsychology New York; Oxford University Press 1993
• 23 Humphreys G W, Watele A, Riddoch M. Long-term effects of prism adaptation in chronic visual neglect: A single case study.  Cogn Neuropsychol. 2006;  23 463-478
• 24 Johannsen L, Ackermann H, Karnath H. Lasting amelioration of spatial neglect by treatment with neck muscle vibration even without concurrent training.  J Rehabil Med. 2003;  35 249-253
• 25 Kalra L, Perez I, Gupta S. et al . The influence of visual neglect on stroke rehabilitation.  Stroke. 1997;  28 1386-1391
• 26 Katz N, Hartman-Maeir A, Ring H. et al . Funcional disability and rehabilitation outcome in right hemisphere damaged patients with and without unilateral spatial neglect.  Arch Phys Med Rehabil. 1999;  80 379-384
• 27 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
• 28 Kerkhoff G. Spatial hemineglect in humans.  Prog Neurobiol. 2001;  63 1-27
• 29 Kielhofner G. A model of human occupation. Baltimore; Lippincott Williams & Wilkins 2002
• 30 Kim K, Kim J, Ku J. et al . A Virtual Reality Assessment and Training System for Unilateral Neglect.  Cyberpsychol Behav. 2004;  7 749
• 31 Van der Lee J H, Wagenaar R C, Lankhorst G J. et al . Forced use of the upper extremity in chronic stroke patients: results from a single-blind randomized clinical trial.  Stroke. 1999;  30 2369-2375
• 32 Lennon S. Wheelchair transfer training in a stroke patient with neglect: A single case study design.  Physiother Theory Pract. 1991;  7 51-55
• 33 Lin K C. Right-hemispheric activation approaches to neglect rehabilitation poststroke.  Am J Occup Ther. 1996;  50 504-515
• 34 Lincoln N B, Majid M J, Weyman N. Cognitive rehabilitation for attention deficits following stroke.  Cochrane Database Syst Rev. 2000;  CD002842
• 35 Luaute J, Halligan P, Rode G. et al . Visuo-spatial neglect: A systematic review of current interventions and their effectiveness.  Neurosci Biobehav Rev. 2006;  30 961-982
• 36 Maddicks R, Marzillier S L, Parker G. Rehabilitation of unilateral neglect in the acute recovery stage: the efficacy of limb activation therapy.  Neuropsychol Rehabil. 2003;  13 391-408
• 37 Manly T. Cognitive rehabilitation for unilateral neglect: Review.  Neuropsychol Rehabil. 2002;  12 310
• 38 McCarthy M, Beaumont J G, Thompson R. et al . The role of imagery in the rehabilitation of neglect in severely disabled brain-injured adults.  Arch Clin Neuropsychol. 2002;  17 422
• 39 McGlynn S M, Schacter D L. Unawareness of deficits in neuropsychological syndromes.  J Clin Exp Neuropsychol. 1989;  11 143-205
• 40 McIntosh R D, Rossetti Y, Milner A D. Prism adaptation improves chronic visual and haptic neglect: a single case study.  Cortex. 2002;  38 309-320
• 41 Meyer A. The philosophy of occupational therapy.  Archives of occupational therapy. 1922;  1 1-10
• 42 Van Nes I JW, Latou H PT, Schils F PT. et al . Long-Term Effects of 6-Week Whole-Body Vibration on Balance Recovery and Activities of Daily Living in the Postacute Phase of Stroke: A Randomized, Controlled Trial.  Stroke. 2006;  37 2331-2335
• 43 Niemeier J P. The Lighthouse Strategy: use of a visual imagery technique to treat visual inattention in stroke patients.  Brain Injury. 1998;  12 399-406
• 44 Niemeier J P, Cifu D X, Kishore R. The lighthouse strategy: improving the functional status of patients with unilateral neglect after stroke and brain injury using a visual imagery intervention.  Top Stroke Rehabil. 2001;  8 10-18
• 45 Niemeier J P. Grand rounds. Visual imagery training for patients with visual perceptual deficits following right hemisphere cerebrovascular accidents: a case study presenting the Lighthouse Strategy.  Rehabil Psychol. 2002;  47 426-437
• 46 Paolucci S, Antonucci G, Guariglia C. et al . Facilitatory effect of neglect rehabilitation on the recovery of left hemiplegic stroke patients: a cross cover study.  J Neurol. 1996;  243 308-314
• 47 Paolucci S, Antonucci G, Pratesi L. et al . Functional outcome in stroke inpatient rehabilitation: predicting no, low, and high response patients.  Cerbrovasc Dis. 1998;  8 228-234
• 48 Parton A, Malhotra P, Husain M. Hemispatial neglect [Review].  Journal of Neurology, Neurosurgery & Psychiatry. 2004;  75 13-21
• 49 Pierce S R, Buxbaum L J. Treatments of unilateral neglect: a review.  Arch Phys Med Rehabil. 2002;  83 256-268
• 50 Prangrat T, Mann W C, Tomita M. Impact of unilateral neglect on assistive device use.  Technology and Disability. 2000;  12 53-69
• 51 Punt T D, Riddoch M J. Motor neglect: implications for movement and rehabilitation following stroke.  Disabil Rehabil. 2006;  28 857-864
• 52 Rijken P M, Dekker J. Clinical experience of rehabilitation therapists with chronic diseases: A quantitative approach.  Clin Rehabil. 1998;  12 143-150
• 53 Robertson I H, North N T, Geggie C. Spatiomotor cueing in unilateral left neglect: Three case studies of its therapeutic effects.  Journal of Neurology, Neurosurgery & Psychiatry. 1992;  55 805
• 54 Robertson I H, Nico D, Hood B M. The intention to act improves unilateral left neglect: two demonstrations.  Neuroreport. 1995;  7 246-248
• 55 Robertson I H, Tegner R, Tham K. et al . Sustained attention training for unilateral neglect: theoretical and rehabilitation implications.  J Clin Exp Neuropsychol. 1995;  17 416-430
• 56 Robertson I H, Manly T, Beschin N. et al . Auditory sustained attention is a marker of unilateral spatial neglect.  Neuropsychologia. 1997;  35 1527-1532
• 57 Robertson I H, Hogg K, McMillan T M. Rehabilitation of unilateral neglect: Improving function by contralesional limb activation.  Neuropsychol Rehabil. 1998;  8 29
• 58 Robertson I H, Mattingley J B, Rorden C. et al . Phasic alerting of neglect patients overcomes their spatial deficit in visual awareness.  Nature. 1998;  395 169-172
• 59 Robertson I H, Murre J M. Rehabilitation of Brain Damage: Brain Plasticity and Principles of Guided Recovery.  Psychol Bull. 1999;  125 544-575
• 60 Robertson I H, McMillan T M, MacLeod E. et al . Rehabilitation by limb activation training reduces left-side motor impairment in unilateral neglect patients: A single-blind randomised control trial.  Neuropsychol Rehabil. 2002;  12 454
• 61 Rode G, Tiliket C, Boisson D. Predominance of postural imbalance in left hemiparetic patients.  Scand J Rehabil Med. 1997;  29 11-16
• 62 Rode G, Rossetti Y, Boisson D. Prism adaptation improves representational neglect.  Neuropsychologia. 2001;  39 1250-1254
• 63 Rossetti Y, Rode G, Pisella L. et al . Prism adaptation to a rightward optical deviation rehabilitates left hemispatial neglect.  Nature. 1998;  395 166-169
• 64 Samuel C, Louis-Dreyfus A, Kaschel R. et al . Rehabilitation of very severe unilateral neglect by visuo-spatio-motor cueing: Two single case studies.  Neuropsychol Rehabil. 2000;  10 385-399
• 65 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
• 66 Serino A, Angeli V, Frassinetti F. et al . Mechanisms underlying neglect recovery after prism adaptation.  Neuropsychologia. 2006;  44 1078
• 67 Stanton K M, Pepping M, Brockway J O. et al . Wheelchair transfer training for right cerebral dysfunction: An interdisciplinary approach.  Arch Phys Med Rehabil. 1983;  64 276-280
• 68 Steultjens E MJ, Dekker J P, Bouter L MP. et al . Occupational Therapy for Stroke Patients: A Systematic Review.  Stroke. 2003;  34 676-687
• 69 Stone S P, Wilson B, Wroot A. et al . The assessment of visuo-spatial neglect after acute stroke.  J Neurol Neurosurg Psychiatry. 1991;  54 345-350
• 70 Sunderland A, Wade D T, Hewer R L. The natural history of visual neglect after stroke: indications from two methods of assessment.  J Int Disabil Stud. 1987;  9 55-59
• 71 Tham K, Ginsburg E, Fisher A G. et al . Training to improve awareness of disabilities in clients with unilateral neglect.  Am J Occup The. 2001;  55 46-54
• 72 Towle D, Lincoln N B. Development of a questionnaire for detecting everyday problems in stroke patients with unilateral visual neglect. Clin Rehabil 1991 5: 135-140
• 73 Walker R, Young A, Lincoln N. Eye patching and the rehabilitation of visual neglect.  Neuropsychol Rehabil. 1996;  6 219-231
• 74 Webster J S, McFarland P T, Rapport L J. et al . Computer-assisted training for improving wheelchair mobility in unilateral neglect patients.  Arch Phys Med Rehabil. 2001;  82 769-775
• 75 Weinfeld D F. The National Survey of Stroke.  Stroke. 1981;  12 1-91
• 76 Weiss P L, Naveh Y, Katz N. Design and testing of a virtual environment to train stroke patients with unilateral spatial neglect to cross a street safely.  Occup Ther Int. 2003;  10 39-55
• 77 Wenman R, Bowen A, Tallis R C. et al . Use of a randomised single case experimental design to evaluate therapy for unilateral neglect.  Neuropsychol Rehabil. 2003;  13 459
• 78 Wiart L, Bon Saint C A, Debelleix X. et al . Unilateral neglect syndrome rehabilitation by trunk rotation and scanning training.  Arch Phys Med Rehabil. 1997;  78 424-429
• 79 Wilcock A. An Occupational Perspective of Health. Thorofare; Slack 1998
• 80 Wilson F C, Manly T, Coyle D. et al . The effect of contralesional limb activation training and sustained attention training for self-care programmes in unilateral spatial neglect.  Restor Neurol Neurosci. 2000;  16 1-4
• 81 Wilson F C, Manly T. Sustained attention training and errorless learning facilitates self-care functioning in chronic ipsilesional neglect following severe traumatic brain injury.  Neuropsychol Rehabil. 2003;  13 548
• 82 Mackay J, Mensah G. World Health Organisation (WHO) .Atlas of Heart, Disease and Stroke. Geneva; WHO 2004