Zusammenfassung
Die Wirkung übender Therapieverfahren wie Krankengymnastik, Ergotherapie und Logopädie auf die motorischen Störungen bei idiopathischer Parkinson-Erkrankung wurde bisher nur in wenigen, meist relativ kleinen und methodisch oft unzureichenden Studien untersucht. Theoretisch lässt sich aus den der Akinese zugrunde liegenden neurobiologischen Störungen folgern, dass adjuvante Therapieverfahren auf eine Substitution der bei Parkinson-Erkrankung vermindert generierten internalen Steuerungssignale und eine Verbesserung der Integration propriozeptiver Afferenzen ausgerichtet sein sollte. Einige kleinere kontrollierte Studien konnten zeigen, dass die Verwendung unterstützender sensorischer Signale („Cues”), gezieltes Üben von Ausfallschritten, Training des Sprechvolumens und andere spezifisch auf typische motorische Defizite der Parkinson-Erkrankung ausgerichtete Therapieansätze zu messbaren Verbesserungen der motorischen Performance führen. Diese Übersicht gibt einen Überblick über die konzeptionellen und neurophysiologischen Grundlagen adjuvanter Therapie bei Parkinson-Erkrankung und diskutiert die vorhandenen klinischen Studien.
Abstract
The effect of training procedures including physiotherapy, behavioral and speech therapy on motor performance in Parkinson's disease have only been studied in a small number of studies which are often characterised by methodological shortcomings. In theory, the neurobiological background of akinesia suggests that rehabilitative therapy should aim at substituting defective internal cueing and at improving sensory perception. In several controlled trials therapeutic use of sensory cues, training of compensatory steps, speech therapy focussing on voice volume and other strategies adapted to specific demands of motor disturbances in Parkinson's disease have been shown to effectively improve motor performance in a small number of subjects. In this paper conceptual and neurobiological basics of rehabilitative therapy in Parkinson's disease and application of therapeutic strategies in clinical studies will be reviewed.
Literatur
-
1
Weiner W J, Singer C.
Parkinson's disease and non-pharmacological treatment programs.
J Am Geriatr Soc.
1989;
37
359-363
-
2
Goetz C G, Koller W C, Poewe W. et al .
Management of Parkinson's disease: An evidence-based review.
Mov Disord.
2002;
17, Suppl 4
S156-S166
-
3 Deane K H, Jones D, Playford E D. et al .Physiotherapy for patients with Parkinson's disease (Cochrane review). Cochrane Database Syst Rev 2001 3: CD002817
-
4 Spottke A, Peter H, Reuter M. et al .Costs of Parkinson's disease in Germany. Pharmacoeconomics 2005, im Druck
-
5
Bonnet A M, Loria Y, Saint-Hilaire M H. et al .
Does long-term aggravation of Parkinson's disease result from nondopaminergic lesions?.
Neurology.
1987;
37
1539-1542
-
6
Giladi N, McMahon D, Przedborski S. et al .
Motor blocks in Parkinson's disease.
Neurology.
1992;
42
333-339
-
7
Gauthier L, Dalziel S, Gautier S.
The benefits of group occupational therapy for patients with Parkinson's disease.
Am J Occup Ther.
1987;
41
360-365
-
8
Comella C L, Stebbins G T, Brown-Toms N, Goetz C G.
Physical therapy and Parkinson's disease: a controlled clinical trial.
Neurology.
1994;
44
376-378
-
9
Morris M E, Iansek R, Matyas T A, Summers J J.
Stride length regulation in Parkinson's disease. Normalisation strategies and underlying mechanisms.
Brain.
1996;
119
551-568
-
10
Wade D T, Gage H, Owen C. et al .
Multidisciplinary rehabilitation for people with Parkinson's disease: a randomised controlled study.
J Neurol Neurosurg Psychiatry.
2003;
74
158-162
-
11
Marsden C D.
The mysterious motor function of the basal ganglia: the Robert Wartenberg Lecture.
Neurology.
1982;
32
514-539
-
12
Brotchie P, Iansek R, Horne M K.
Motor function of the monkey globus pallidus. 1. Neuronal discharge and parameters of movement.
Brain.
1991;
114
1667-1683
-
13
Georgiou N, Iansek R, Bradshaw J. et al .
An evaluation of the role of internal cues in the pathogenesis of parkinsonian hypokinesia.
Brain.
1993;
116
1575-1587
-
14
Benecke R, Rothwell J C, Dick J PR. et al .
Performance of simultaneous movements in patients with Parkinson's disease.
Brain.
1986;
109
739-757
-
15
Abbruzzese G, Berardelli A.
Sensorimotor integration in movement disorders.
Mov Disord.
2003;
18
231-240
-
16
Klockgether T, Borutta M, Rapp H. et al .
A defect of kinesthesia in Parkinson's disease.
Mov Disord.
1995;
10
460-465
-
17
Moore A P.
Impaired sensorimotor integration in parkinsonism and dyskinesias: a role of corollary discharges?.
J Neurol Neurosurg Psychiatry.
1987;
50
544-552
-
18
Demirci M, Grill S, McShane L, Hallelett M.
A mismatch between kinaesthetic and visual perception in Parkinson's disease.
Ann Neurol.
1997;
41
781-788
-
19
Fellows S J, Noth J, Schwarz M.
Precision grip and Parkinson's disease.
Brain.
1998;
121
1771-1784
-
20
Marchese R, Diverio M, Zucchi F. et al .
The role of sensory cues in the rehabilitation of parkinsonian patients: a comparison of two physical therapy protocols.
Mov Disord.
2000;
15
879-883
-
21
Azulay J, Mesure S, Amblard B. et al .
Visual control of locomotion in Pakinson's disease.
Brain.
1999;
117
1169-1181
-
22
Palmer S S, Mortimer J A, Webster D D.
Exercise therapy for Parkinson's disease.
Arch Phys Med Rehabil.
1986;
67
741-745
-
23
Katsikitis M, Pilowsky I.
A controlled study of facial mobility treatment in Parkinson's disease.
J Psychosom Res.
1996;
40
387-396
-
24
Schenkman M, Cutson T M, Kuchibhatla M. et al .
Exercise to improve spinal flexibility and function for people with Parkinson's disease: a randomised controlled study.
J Am Geriatr Soc.
1998;
46
1207-1221
-
25
Thaut M H, McIntosh G C, Rice R R. et al .
Rhythmic auditory stimulation in gait training for Parkinson's disease patients.
Mov Disord.
1996;
11
193-200
-
26 Martin J P. The basal ganglia and posture. London; Pitman 1967
-
27
Dietz M A, Goetz C G, Stebbins G T.
Evaluation of a modified inverted walking stick as a treatment for parkinsonian freezing episodes.
Mov Disord.
1990;
5
243-247
-
28
Stern G M, Lander C M, Lees A J.
Akinetic freezing and trick movements in Parkinson's disease.
J Neural Transm.
1980;
16 (Suppl)
137-141
-
29
Rubinstein T C, Giladi N, Hausdorff J M.
The power of cueing to circumvent dopamine deficits: a review of physical therapy treatment of gait disturbances in Parkinson's disease.
Mov Disord.
2002;
17
1148-1160
-
30
Dam M, Tonin P, Casson S.
Effects of conventional and sensory-enhanced physiotherapy on disability of Parkinson's disease patients.
Adv Neurol.
1996;
69
551-555
-
31
Morris M E, Iansek R, Matyas T A, Summers J J.
Ability to modulate walking cadence remains intact in Parkinson's disease.
J Neurol Neurosurg Psychiatry.
1994;
57
1532-1534
-
32
McIntosh G C, Brown S H, Rice R R, Thaut M H.
Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson's disease.
J Neurol Neurosurg Psychiatry.
1997;
62
22-26
-
33
Behrman A, Teitelbaum P, Cauraugh J.
Verbal instructional sets to normalize the temporal and spatial gait variables in Parkinson's disease.
J Neurol Neurosurg Psychiatry.
1998;
65
580-582
-
34
Jöbges M, Heuschkel G, Pretzel C. et al .
Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson's disease.
J Neurol Neurosurg Psychiatry.
2004;
75
1682-1687
-
35
Hirsch M A, Toole T, Maitland C G, Rider R A.
The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease.
Arch Phys Med Rehabil.
2003;
84
1109-1117
-
36
Bloem B R, Hausdorff J M, Visser J E, Giladi N.
Falls and freezing of gait in Parkinson's disease: a review of two interconnected, episodic phenomena.
Mov Disord.
2004;
19
871-884
-
37
Ramig L O, Countryman S, O'Brien C. et al .
Intensive speech treatment for patients with Parkinson's disease: short- and long-term comparison of two techniques.
Neurology.
1996;
47
1496-1504
-
38
Ramig L O, Sapir S, Fox C, Countryman S.
Changes in vocal loudness following intensive voice treatment (LSVT) in individuals with Parkinson's disease: a comparison with untreated patients and normal age-matched controls.
Mov Disord.
2001;
16
79-83
-
39
Robertson S J, Thomson F.
Speech therapy in Parkinson's disease: a study of the efficacy ad long-term effects of intensive treatment.
Br J Disord Commun.
1984;
19
213-224
-
40
Johnson J A, Prang T R.
Speech therapy and Parkinson's disease: a review and further data.
Br J Disord Commun.
1990;
25
183-194
PD Dr. Georg Ebersbach
Neurologisches Fachkrankenhaus für Bewegungsstörungen/Parkinson
Paracelsusring 6 a
14547 Beelitz-Heilstätten
Email: ebersbach@parkinson-beelitz.de
