Subscribe to RSS
Please copy the URL and add it into your RSS Feed Reader.
https://www.thieme-connect.de/rss/thieme/en/10.1055-s-00000160.xml
neuroreha 2010; 2(3): 126-132
DOI: 10.1055/s-0030-1265124
DOI: 10.1055/s-0030-1265124
Schwerpunkt Tonuserhöhung: Aus der Praxis
© Georg Thieme Verlag KG Stuttgart · New York
Therapeutische Maßnahmen zur Tonusreduktion
Further Information
Publication History
Publication Date:
06 September 2010 (online)

Zusammenfassung
Die spastische Erhöhung des Muskeltonus im Rahmen eines Upper-Motor-Neuron-Syndroms ist nicht statisch, es handelt sich um einen dynamischen Prozess. Eine erfolgreiche Behandlung ist selten durch eine singuläre Therapiemaßnahme zu erreichen. Vielmehr ist die Kombination von physio- und ergotherapeutischen Therapien, einer Hilfsmittelversorgung, oraler Medikation bzw. fokalen Techniken und der Anleitung zum Selbstmanagement in der Behandlung sinnvoll.
Literatur
- 01 Ada L , O’Dwyer N , O’Neill E . Relation between spasticity, weakness and contracture of the elbow flexors and upper limb activity after stroke: an observational study. Disabil Rehabil. 2006; 28 891-897
- 02 Barnes M P. Local treatment of spasticity. Bailliere‘s Clin Neurol. 1993; 2 5-71
- 03 Bell K R, Lehmann J F. Effect of cooling on H- and T-reflexes in normal subjects. Arch Phys Med Rehabil. 1987; 68 490-493
- 04 Blasi J , Chapmann E , Link E et al.. Botulinum neurotoxin A selectively cleaves the synapse protein SNAP-25. Nature. 1993; 365 160-163
- 05 Bohannon R , Larkin P . Passive ankle dorsiflexion increases in patients after a regimen of tilt table-wedge board standing. Phys Ther. 1985; 65 1676-1678
- 06 Boyd R A, Ada L . Physiotherapy management of spasticity. In: Barnes M P, Johnson G R Upper Motor Neuron Syndrome and Spasticity. New Cambridge University Press; Cambridge; 2008: 79-98
- 07 Bruton A . Muscle plasticity: response to training and de-training. Physiotherapy. 2002; 88 398-408
- 08 Burridge J H, Taylor P N, Hagan S A et al.. The effects of common peroneal stimulation on the effort and speed of walking: a randomized controlled trial with chronic hemiplegic patients. Clin Rehabil. 1997; 11 201-210
- 09 Bütefisch C , Hummelsheim H , Denzler P et al.. Repetitive training of isolated movements improves the outcome of motor rehabilitation of the centrally paretic hand. J Neurol Sci. 1995; 130 59-68
- 10 Coward D M. Tizanidine: Neuropharmacology and mechanisms of action. Neurology. 1994; 44 6-11
- 11 Duncan G W, Shahani B T, Young R R. An evaluation of baclofen treatment for certain symptoms in patients with spinal cord lesions: a double blind cross over study. Neurology. 1976; 26 441-446
- 12 Eng J , Levins S , Towson A et al.. Use of prolonged standing for individuals with spinal cord injuries. Phys Ther. 2001; 81 1392-1399
- 13 Fujiwar T , Kasashima Y , Honaga K et al.. Motor improvement and corticospinal modulation induced by hybrid assistive neuromuscular dynamic stimulation (HANDS) therapy in patients with chronic stroke. Neurorehab Neural Repair. 2009; 23 125-132
- 14 Hattab J R. Review of European clinical trial with baclofen. In: Feldman R G, Young R R, Koella W P, Eds Spasticity: Disordered Motor Control. Year Book Medical Publishers; Chicago; 1980: 71-85
- 15 Hedenberg L . Functional improvement of spastic hemiplegic arm after coolin. Scand J Rehabil Med. 1970; 2 154-158
- 16 Henry J L. Pharmacological studies on baclofen in the spinal cord of the rat. In: Feldman R G, Young R R, Koella W P, Eds Spasticity: Disordered Motor Control. Year Book Medical Publishers; Chicago; 1980: 437-452
- 17 Hesse S , Konrad M , Uhlenbrock D . Treadmill walking with partial body weight support versus floor walking in hemiparetic subjects. Arch Phys Med Rehabil. 1999; 80 421-427
- 18 Kunze Klaus . Untersuchung und Diagnose. In: Kunze K Praxis der Neurologie. 2. Auflage Thieme; Stuttgart; 1999: 2-62
- 19 Kocsis S , Farkas S , Fodor L et al.. Tolperisone-type drugs inhibit spinal reflexes via blockade of voltage gated sodium and calcium channels. J Pharmacol Exp Ther. 2005; 315 1237-1246
- 20 Lai J M, Francisco G E, Willis F B. Dynamic splinting after treatment with botulinum toxin type-a: a randomized controlled pilot study. Adv Ther. 2009; 26 241-248
- 21 Laitinen L V, Nilsson S , Fugl-Meyer A R. Selective posterior rhizotomy for treatment of spasticity. J Neurosurg. 1983; 58 895-899
- 22 Lange O , Bigalke H , Dengler R et al.. Neutralizing antibodies and secondary therapy failure after treatment with botulinum toxin type A: much ado about nothing?. Clin Neuropharmacol. 2009; 32 213-218
- 23 Lockley L J, Buchanan K . Physical management of spasticity. In: Stevenson V L, Jarrett L , , et al., (Hrsg.) Spasticity management. Taylor & Francis; Boca Raton; 2006: 37-58
- 24 Mehrholz J , Wagner K , Meißner D et al.. Reliability of the modified Tardieu scale and the modified Ashworth scale in adult patients with severe brain injury: a comparison study. Clin Rehabil. 2005; 19 751-759
- 25 Mortenson P A, Eng J J. The use of casts in the management of joint mobility and hypertonia following brain injury in adults: a systematic review. Phys Ther. 2003; 83 648-658
- 26 Mueller M E, Gruenthal M , Olson W L et al.. Gabapentin for relief of upper motor neuron symptoms in multiple sclerosis. Arch Phys Med Rehabil. 1997; 78 521-524
- 27 Ochs G , Struppler A , Meyerson B A et al.. Intrathecal baclofen for long-term treatment of spasticity: a multi-centre study. J Neurol Neurosurg Psychiatry. 1989; 52 933-939
- 28 O‘Dwyer N J, Ada L , Neilson P D. Spasticity and muscle contracture following stroke. DGN Leitlinie 2008 Therapie des spastischen Syndroms Brain. 1996; 119 1737-1749
- 29 Pinder R M, Brodgen R N, Speight T M et al.. Dantrolene sodium: a review of its pharmacological properties and therapeutic efficacy in spasticity. Drugs. 1977; 13 3-23
- 30 Price R , Lehmann J F. Influence of muscle cooling on the viscoelastic response of the human ankle to sinusoidal displacements. Arch Phys Med Rehabil. 1990; 71 745-748
- 31 Price G , Wilkin G P, Turnbull M J et al.. Are baclofen sensitive GABA-B receptors present on primary afferent terminals of the spinal cord?. Nature. 1984; 307 71-73
- 32 Putty T K, Shapiro S A. Efficacy of dorsal longitudinal myelotomy in treating spinal spasticity: a review of 20 cases. J Neurosurg. 1991; 75 397-401
- 33 Roussan M , Terrence C , Fromm G . Baclofen versus diazepam for the treatment of spasticity and long term follow-up of baclofen-therapy. Pharmacotherapeutica. 1987; 4 278-284
- 34 Schantz E J, Johnson E A. Botulinum toxin: the story of the development for the treatment of human disease. Perspect Biol Med. 1997; 40 317-327
- 35 Schmit B D, Dewald J P, Rymer W Z. Stretch reflex adaptation in elbow flexors during repeated passive movements in unilateral brain-injured patients. Ach Phys Med Rehabil. 2000; 81 269-278
- 36 Simpson D M, Alexander D N, O’Brian C F et al.. Botulinum toxin type a in the treatment of upper extremity spasticity: A randomized, double-blind, placebo-controlled trial. Neurology. 1996; 46 1306-1310
- 37 Stamenova P , Koytchev R , Kuhn K et al.. A randomized double-blind, placebo-controlled study of the efficacy and safety of tolperisone in spasticity following cerebral stroke. Eur J Neurol. 2005; 12 453-461
- 38 Stien R , Nordal H J, Oftedal S I et al.. The treatment of spasticity in multiple sclerosis: a double-blind clinical trial of a new anti-spastic drug tizanidine compared with baclofen. Act Neurol Scand. 1987; 75 190-194
- 39 Teixeira-Salmela L F, Olney S J, Nadeau S et al.. Muscle strengthening and physical conditioning to reduce impairment and disability in chronic stroke survivors. Arch Phys Med Rehabil. 1999; 80 1211-1218
- 40 Ward A , Chaqffmann H O, Sorkin E M et al.. Dantrolene: a review of its pharmacokinetic properties and therapeutic use in malignant hyperthermia, the malignant neuroleptic syndrome and an update of its use in muscle spasticity. Drugs. 1986; 32 130-186
- 41 Winchester P , Montgomery J , Bowman B et al.. Effects of feedback stimulation training and cyclicalo electrical stimulation on knee extension in hemiparetic patients. Phys Ther. 1983; 63 1096-1103
- 42 Woldag H , Hummelsheim H . Is the reduction of spasticity by botulinum toxin a beneficial for the recovery of motor function of arm and hand in stroke patients?. Eur Neurol. 2003; 50 165-171
- 43 Zander C L, Healy N L. Elbow flexion contractures treated with serial casts and conservative therapy. J Hand Surg Am. 1992; 17 694-697
Dr. med. Michael Jöbges
Brandenburg Klinik
Brandenburgallee 1
16321 Bernau bei Berlin
Phone: 033397/34001
Fax: 033397/34044
Email: joebges@brandenburgklinik.de