Evidenzbasierte Physiotherapie bei Spastik

Zusammenfassung

Nach zentralen Läsionen treten bei der Funktionsrückkehr zwei gegensätzliche Phänomene auf: Minussymptome wie die Parese und Plussymptome wie die Spastik.

Gerade der Spastiktherapie wird in der neurologischen Physiotherapie ein großer Stellenwert zugeschrieben. Dies spiegelt sich in vielfältigen Definitionen, Erklärungsmodellen und Tests für das Phänomen der Spastik wider. Auch die Behandlungsmethoden sind zahlreich: Traditionell wird das Bobath-Konzept angewendet, obwohl es nur empirische Empfehlungen zur Spastikreduktion gibt und seine Effektivität kontrovers diskutiert wird. Demgegenüber finden Physiotherapeuten in der Literatur evidenzbasierte Richtlinien: 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.

Summary

In the course of regaining motor function after central lesions two different phenomena appear: paralysis, the so called negative symptoms, and spasticity, the so called positive symptoms. Especially the treatment of spastic symptoms is an important part of neurological physiotherapy. This is reflected in a multitude of definitions, etiological explanations and various rating scales for spasticity. Manifold are the treatment options: traditionally the Bobath method is practised even though its use is based on empirical data only and its efficacy is controversial. On the other hand there are evidence based guidelines for physiotherapists to be found in the literature: short or longer lasting stretching exercises of muscles, with or without weight stress 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.

Schlüsselwörter

Physiotherapie - Spastik - Muskeldehnungen - Redression

Keywords

Physiotherapy - spasticity - muscle stretching - casting

• Literatur

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