Motorische Vernachlässigungsphänomene

Zusammenfassung

Viele Patienten, die eine fokale Schädigung ihres Gehirns (z. B. durch einen Schlaganfall oder ein Schädel-Hirn-Trauma) überleben, behalten kognitive Einbußen zurück, die sich nachteilig auf ihre weitere Behandlung und Rehabilitation auswirken. Unilateraler (oder räumlicher) Neglect ist ein solches kognitives Defizit, das die Effektivität der neurologischen Rehabilitation nach einem Schlaganfall besonders stark beeinträchtigt und zu gravierenden Einschränkungen im alltäglichen Leben der Patienten führt [1]. Unter dem Begriff (Hemi- oder räumlicher) Neglect werden Symptome zusammengefasst, die mit einer (halbseitigen) Vernachlässigung des extra-, peri- und/oder personalen Raums einhergehen und die nicht primär durch Störungen der Sensorik oder Motorik bedingt sind [2]. Patienten mit Neglect haben Schwierigkeiten, ihre Aufmerksamkeit in die vernachlässigte kontraläsionale Raumhälfte zu wenden und auf Reize aus dieser Raumhälfte adäquat zu reagieren. Nach gegenwärtigem Kenntnisstand ist es sinnvoll, perzeptive von motorischen Neglectsymptomen abzugrenzen; letztere sind dadurch gekennzeichnet, dass die vom Schlaganfall primär mitbetroffene (kontralaterale), aber nicht plegische Körperhälfte nicht aktiv eingesetzt wird [3], dass aber auch die ipsilaterale vom Schlaganfall primär nicht betroffene Körperhälfte in ihrer aktiven Nutzung eingeschränkt sein kann. Motorischer Neglect beschreibt somit eine verminderte spontane Nutzung der betroffenen Körperhälfte(n) (oder Extremität[en]), die nicht durch das Pareseausmaß, sondern durch eine motorische Aufmerksamkeitsstörung zu erklären ist. Motorischer Neglect führt zu einer Einschränkung der aktiven Teilnahme am Alltag und den Rehabilitationsprogrammen und ist deswegen mit einer schlechteren funktionellen und sozialen Prognose assoziiert. Aus diesem Grunde ist es wichtig, motorische Aspekte räumlicher Neglectsyndrome und verwandter Störungen rechtzeitig zu erkennen.

Abstract

Many patients who survive brain damage (resulting from, e. g., a stroke) are left with a variety of cognitive impairments which adversely affect their treatment, management, and hence also their subsequent recovery. Unilateral neglect is one such cognitive deficit which severely limits the effectiveness of rehabilitation, and curtails many aspects of everyday life [1]. Neglect is not a well-defined syndrome but may rather present as a protean disorder with different behavioural manifestations which share in common the patient's failure to spontaneously report, respond or even orient to objects and events in the hemispace contralateral to a brain lesion, and which cannot be attributed to either primary sensory or motor deficits [2]. Although many manifestations of neglect can be explained in terms of a failure to attend to or perceive objects located in contralesional space (i. e., perceptual neglect), neuropsychological evidence also suggests that neglect can result from response problems (i. e., disorders of action), which in the neglect literature are often referred to as „motor” and „pre-motor” neglect. Motor neglect behaviour is characterized by a „difficulty” to use the contralesional limb spontaneously or to use the ipsilesional limb appropriately when moving into contralesional space. Motor neglect thus refers to a reduced spontaneous use of the affected limb which cannot be explained by a primary motor deficit but rather results from a disorder of motor attention (or intention). Motor neglect behaviour leads to a reduced participation in many activities of daily living and is hence a poor prognostic factor. This bad influence on the patient's outcome necessitates an early diagnosis and treatment of motor forms of neglect.

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