Rehabilitation des Schlaganfalls - Funktionelle Besserung über multimodale Therapieansätze

Obwohl in den letzten Jahren bei der Akutbehandlung des Schlaganfalls wesentliche Fortschritte zu verzeichnen waren (Thrombolyse, Behandlung auf der Stroke Unit), ist der Schlaganfall nach wie vor die Erkrankung, die am häufigsten zu einer dauerhaften Behinderung führt. Deswegen spielt die effektive und möglichst früh einsetzende multimodale Rehabilitationsbehandlung eine wichtige Rolle im Rahmen der Therapie der Betroffenen. Ein besseres Verständnis des natürlichen Verlaufs der funktionellen Reorganisation nach einem Schlaganfall hat dabei dazu beigetragen, das Behandlungsspektrum mithilfe neuer Techniken wesentlich zu erweitern. In den letzten Jahren wurde die Effektivität zahlreicher Verfahren der Schlaganfallrehabilitation in kontrollierten Studien untersucht, sodass mittlerweile - zumindest für bestimmte Verfahren - evidenzbasierte Empfehlungen vorliegen. In der folgenden Übersicht wird der aktuelle Stand der evidenzbasierten Schlaganfallrehabilitation unter besonderer Berücksichtigung der Frührehabilitation dargestellt.

Stroke is the leading cause of long-term major disability in developed countries, although several improvements could be achieved in acute stroke therapy (e. g. thrombolysis, stroke-unit treatment). Therefore, an early onset of an intensive and multimodal rehabilitation workup is of particular importance to reduce stroke morbidity and stroke-related dependency. Stroke rehabilitation was enhanced due to a better understanding of the natural course of functional reorganisation after stroke and the development of techniques to modulate these processes. During the last years several therapeutic strategies for stroke rehabilitation were studied in controlled clinical trials. Therefore, there are evidence-based recommendations available for some of these therapies. This review summarizes the actual status of evidence-based stroke rehabilitation particular focussing on early rehabilitation.

Key words

stroke - rehabilitation - evidence-based therapy - review

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1 EXtremity Constraint Induced Therapy Evaluation

2 Safety and Effectiveness of Cortical Stimulation in the Treatment of Upper Extremity

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