Behandlung der Spastik - Ein physiotherapeutisches Konzept

Nach zentralen Läsionen treten bei Funktionsrückkehr Minussymptome wie die Parese und Plussymptome wie die Spastik auf. Spastische Phänomene behindern die Funktionsrückkehr und stellen deshalb einen Behandlungsschwerpunkt in der neurologischen Physiotherapie dar. Der vorliegende Artikel zeigt Definitionen und Erklärungsmodelle für die Spastik auf und hinterfragt gängige Vorgehensweisen zur Testung. Das weit verbreitete Bobath-Konzept gibt zur Spastikreduktion nur empirische Empfehlungen und seine Effektivität wird kontrovers diskutiert. In der folgenden Übersicht wird ein Behandlungskonzept für Physiotherapeuten dargestellt, das sich auf die Ergebnisse der Literatur stützt: Kurze und langanhaltende Muskeldehnungen mit oder ohne Gewichtsbelastung senken die Spastik nachweislich. Sie können vorbereitend durch Kälte- oder Wärmetherapie unterstützt werden. Lagerungsschienen gewährleisten eine Dehnung auch außerhalb der Therapie. Bei spastisch bedingten kontrakten Fehlstellungen sollten zirkuläre Gipsverbände eingesetzt werden. Ein antagonistisches Muskeltraining reduziert die Spastik ebenfalls, wirkt der Parese aktiv entgegen und begegnet Plus- und Minussymptomen im Kontext.

After central lesions two different phenomena appear: paralysis, the so called negative symptoms, and spasticity, the so called positive symptoms. As spasticity opposes regaining function the treatment of spastic symptoms is an important part of neurological physiotherapy. This paper reviews definitions, etiological explanations and various rating scales for spasticity. Traditionally the Bobath method is practised even though its use is based on empirical data only and its efficacy is controversial. The following article shows a physiotherapeutic treatment concept, which is based on research results: short or longer lasting stretching exercises of muscles, with or without weight load have proven to improve spasticity significantly. Thermal therapy, hot or cold, before treatment seems to improve outcome. To provide stretching of muscles at home or at night splinting can be used. In the case of spastic contractures circular casts can be applied. Finally exercising antagonistic muscles reduces spasticity and paralysis, therefore improving positive and negative symptoms alike.

Physiotherapy - spasticity - muscle stretching - casting

Literatur

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