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.

Schlüsselwörter

unilateraler Neglekt - Schlaganfall - Rehabilitation - Ergotherapie

Key words

unilateral neglect - stroke - rehabilitation - occupational therapy

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