Physiotherapie in Deutschen Perinatalzentren

Zusammenfassung

Hintergrund Einheitliche Empfehlungen für stationäre und ambulante Physiotherapie bei Frühgeborenen fehlen in Deutschland. Ziel dieser Studie war die Untersuchung der Verordnungspraxis deutscher Perinatalzentren. Werden standardisierte Assessments zur Indikationsstellung genutzt? Welchen Stellenwert nimmt das General Movements Assessment in der postnatalen Diagnostik ein?

Methodik Online-Befragung der deutschen Perinatalzentren mit 21 Fragen zur Indikationsstellung und Verordnungspraxis für stationäre und ambulante Physiotherapie in der Versorgung Frühgeborener, sowie den Kenntnissen zum General Movements Assessment und deren klinische Anwendung via Lime-Survey.

Ergebnisse 81% der Teilnehmer empfehlen indikationsbasiert „immer“ oder „häufig“ stationäre Physiotherapie für Frühgeborene, 53% empfehlen „immer“/„häufig“ ambulante Therapie. Die Indikationsstellung erfolgt v. a. bei diesen Symptomen (N=344) und Diagnosen (N=273) (Mehrfachnennungen): Hypotonie (94%), Tonusregulationsstörung (92%), neurologische Auffälligkeiten (97%) und Hirnschädigungen (94%). Standardisierte Testungen nutzen 41% der Teilnehmer. Das General Movements Assessment ist in 87% der Zentren bekannt, 11% setzen sie mehrmals in der Woche, 17% mehrmals im Monat zur Indikationsstellung ein.

Schlussfolgerung Physiotherapie wird bei Frühgeborenen häufig verordnet. Die Indikationsstellung erfolgt primär nach Symptom- oder Krankheitsbild, weniger anhand standardisierter Testverfahren. Das General Movements Assessment ist eine weithin bekannte, jedoch klinisch noch nicht allgemein eingesetzte Methode.

Abstract

Background Standardized recommendations for inpatient and outpatient physiotherapy for preterm infants are lacking in Germany. The aim of this study was to investigate the prescription practice in German neonatal intensive care units. Are standardized assessments used to determine indications? How important is the General Movements Assessment in postnatal diagnostics?

Methods We conducted an online survey in German neonatal intensive care units asking 21 questions on indication and prescription practices for inpatient and outpatient physiotherapy in preterm infantsʼ care as well as on General Movements Assessment and its clinical application via Lime Survey.

Results 81% of the participating sites “always” or “often” recommend indication-based inpatient physiotherapy for preterm infants and 53% “always”/“often” recommend outpatient therapy. Indications are mainly based on these symptoms (N=344) or diagnoses (N=273) (multiple answers): hypotonia (94%), abnormal and imbalanced muscle tone (92%), neurological abnormalities (97%) and brain damage (94%). Standardized testing is used by 41% of the participants. The General Movements Assessment is known to 87% of the neonatal intensive care units, 11% use it several times a week, 17% several times a month for indication of physiotherapy.

Conclusion Physiotherapy is frequently prescribed for preterm infants. The majority of indications are based on symptoms or clinical pictures rather than on standardized tests. The General Movements Assessment is a widely known method but not systematically applied at the moment.

Schlüsselwörter

Perinatalzentrum - Frühgeborene - Physiotherapie - General Movements

Key words

neonatal intensive care units - preterm infants - physiotherapy - general movements

Publication History

Received: 22 February 2022

Accepted: 07 March 2022

Article published online:
20 May 2022

• Literatur

• 1 Løhaugen GCC, Gramstad A, Evensen KAI. et al. Cognitive profile in young adults born preterm at very low birthweight. Dev Med Child Neurol 2010; 52: 1133-1138 DOI: 10.1111/j.1469-8749.2010.03743.x.
• 2 Twilhaar ES, Wade RM, Kieviet JFde. et al. Cognitive Outcomes of Children Born Extremely or Very Preterm Since the 1990s and Associated Risk Factors: A Meta-analysis and Meta-regression. JAMA Pediatr 2018; 172: 361-367 DOI: 10.1001/jamapediatrics.2017.5323.
• 3 Volpe JJ. Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances. The Lancet Neurology 2009; 8: 110-124 DOI: 10.1016/S1474-4422(08)70294-1.
• 4 Bultmann C-S, Fukuda S, Häusler M. et al. Früherkennung der Infantilen Zerebralparese. Neonatologie Scan 2017; 06: E1-E1 DOI: 10.1055/a-0577-6333.
• 5 Kinsner-Ovaskainen A, Lanzoni M, Delobel M. et al. Surveillance of cerebral palsy in Europe: development of the JRC SCPE central database and public health indicators. EUR 28935 EN. Luxembourg: Publications Office of the European Union; 2017. DOI: 10.2760/342293
• 6 Hafström M, Källén K, Serenius F. et al. Cerebral Palsy in Extremely Preterm Infants. Pediatrics 2018; 141: e20171433 DOI: 10.1542/peds.2017-1433.
• 7 van Haastert IC, Groenendaal F. Uiterwaal CSPM. et al. Decreasing incidence and severity of cerebral palsy in prematurely born children. J Pediatr 2011; 159: 86-91.e1 DOI: 10.1016/j.jpeds.2010.12.053.
• 8 Sellier E, Platt MJ, Andersen GL. et al. Decreasing prevalence in cerebral palsy: a multi-site European population-based study, 1980 to 2003. Dev Med Child Neurol 2016; 58: 85-92 DOI: 10.1111/dmcn.12865.
• 9 Petrini JR, Dias T, McCormick MC. et al. Increased risk of adverse neurological development for late preterm infants. J Pediatr 2009; 154: 169-176 DOI: 10.1016/j.jpeds.2008.08.020.
• 10 Morgan C, Fetters L, Adde L. et al. Early Intervention for Children Aged 0 to 2 Years With or at High Risk of Cerebral Palsy: International Clinical Practice Guideline Based on Systematic Reviews. JAMA Pediatr 2021; DOI: 10.1001/jamapediatrics.2021.0878.
• 11 Morgan C, Darrah J, Gordon AM. et al. Effectiveness of motor interventions in infants with cerebral palsy: a systematic review. Dev Med Child Neurol 2016; 58: 900-909 DOI: 10.1111/dmcn.13105.
• 12 Soloveichick M, Marschik PB, Gover A. et al. Movement Imitation Therapy for Preterm Babies (MIT-PB): a Novel Approach to Improve the Neurodevelopmental Outcome of Infants at High-Risk for Cerebral Palsy. J Dev Phys Disabil 2020; 32: 587-598 DOI: 10.1007/s10882-019-09707-y.
• 13 Novak I, Morgan C, Adde L. et al. Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment. JAMA Pediatr 2017; 171: 897-907 DOI: 10.1001/jamapediatrics.2017.1689.
• 14 Einspieler C, Zhang D, Marschik PB. Die Bedeutung fötaler und neonataler Motorik für die kindliche Entwicklung und die Früherkennung von Entwicklungsstörungen. Kindheit und Entwicklung 2021; 30: 6-14 DOI: 10.1026/0942-5403/a000323.
• 15 Morgan C, Romeo DM, Chorna O. et al. The Pooled Diagnostic Accuracy of Neuroimaging, General Movements, and Neurological Examination for Diagnosing Cerebral Palsy Early in High-Risk Infants: A Case Control Study. J Clin Med 2019; 8 DOI: 10.3390/jcm8111879.
• 16 Prechtl HFR, Einspieler C, Cioni G. et al. An early marker for neurological deficits after perinatal brain lesions. The Lancet 1997; 349: 1361-1363 DOI: 10.1016/S0140-6736(96)10182-3.
• 17 Einspieler C, Prechtl HFR. Prechtl’s assessment of general movements: a diagnostic tool for the functional assessment of the young nervous system. Ment Retard Dev Disabil Res Rev 2005; 11: 61-67 DOI: 10.1002/mrdd.20051.
• 18 Einspieler C, Marschik PB, Prechtl HF. Human Motor Behavior. Zeitschrift für Psychologie/Journal of Psychology 2008; 216: 147-153 DOI: 10.1027/0044-3409.216.3.147.
• 19 Einspieler C, Prayer D, Marschik PB. Fetal movements: the origin of human behaviour. Dev Med Child Neurol 2021; 63: 1142-1148 DOI: 10.1111/dmcn.14918.
• 20 Spittle A, Orton J, Anderson PJ. et al. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev 2015; CD005495 DOI: 10.1002/14651858.CD005495.pub4.
• 21 Baumann N, Tresilian J, Wolke D. Effects of infant motor problems and treatment with physiotherapy on child outcomes at school-age. Early Hum Dev 2020; 149: 105140 DOI: 10.1016/j.earlhumdev.2020.105140.
• 22 Bolk J, Farooqi A, Hafström M. et al. Developmental Coordination Disorder and Its Association With Developmental Comorbidities at 6.5 Years in Apparently Healthy Children Born Extremely Preterm. JAMA Pediatr 2018; 172: 765-774 DOI: 10.1001/jamapediatrics.2018.1394.
• 23 Maharaj SS, Lallie R. Does a physiotherapy programme of gross motor training influence motor function and activities of daily living in children presenting with developmental coordination disorder?. S Afr J Physiother 2016; 72: 304 DOI: 10.4102/sajp.v72i1.304.
• 24 Offor N, Ossom Williamson P, Caçola P. Effectiveness of Interventions for Children With Developmental Coordination Disorder in Physical Therapy Contexts: A Systematic Literature Review and Meta-Analysis. Journal of Motor Learning and Development 2016; 4: 169-196 DOI: 10.1123/jmld.2015-0018.
• 25 Smits-Engelsman BCM, Blank R, van der Kaay A-C. et al. Efficacy of interventions to improve motor performance in children with developmental coordination disorder: a combined systematic review and meta-analysis. Dev Med Child Neurol 2013; 55: 229-237 DOI: 10.1111/dmcn.12008.
• 26 Hadders-Algra M. General movements: A window for early identification of children at high risk for developmental disorders. J Pediatr 2004; 145: S12-S18 DOI: 10.1016/j.jpeds.2004.05.017.
• 27 Einspieler C, Bos AF, Ferrari F. et al. Prechtl’s Method of the Qualitative Assessment of General Movements in Preterm, Term and Young Infants. London: Mac Keith Press; 2004
• 28 Einspieler C, Bos AF, Libertus ME. et al. The General Movement Assessment Helps Us to Identify Preterm Infants at Risk for Cognitive Dysfunction. Front Psychol 2016; 7: 406 DOI: 10.3389/fpsyg.2016.00406.
• 29 Kwong AKL, Fitzgerald TL, Doyle LW. et al. Predictive validity of spontaneous early infant movement for later cerebral palsy: a systematic review. Dev Med Child Neurol 2018; 60: 480-489 DOI: 10.1111/dmcn.13697.
• 30 Ferrari F, Cioni G, Prechtl H. Qualitative changes of general movements in preterm infants with brain lesions. Early Hum Dev 1990; 23: 193-231 DOI: 10.1016/0378-3782(90)90013-9.
• 31 Sokołów M, Adde L, Klimont L. et al. Early intervention and its short-term effect on the temporal organization of fidgety movements. Early Hum Dev 2020; 151: 105197 DOI: 10.1016/j.earlhumdev.2020.105197.
• 32 Jung MW, Landenberger M, Jung T. et al. Vojta therapy and neurodevelopmental treatment in children with infantile postural asymmetry: a randomised controlled trial. J Phys Ther Sci 2017; 29: 301-306 DOI: 10.1589/jpts.29.301.
• 33 Friedman H, Soloveichick M, Kushnir A. et al. INA Early Intervention for Babies at Risk. In: Neurodevelopment and Neurodevelopmental Disease Working Title. IntechOpen; 2019. DOI: 10.5772/intechopen.83610
• 34 Hebb DO. The organization of behavior: A neuropsychological theory. Mahwah, NJ: Erlbaum; 2002
• 35 Martin JH. The corticospinal system: from development to motor control. Neuroscientist 2005; 11: 161-173 DOI: 10.1177/1073858404270843.
• 36 Williams PTJA, Jiang Y-Q, Martin JH. Motor system plasticity after unilateral injury in the developing brain. Dev Med Child Neurol 2017; 59: 1224-1229 DOI: 10.1111/dmcn.13581.
• 37 Theobald A. Praxis Online-Marktforschung. Grundlagen – Anwendungsbereiche – Durchführung. Wiesbaden: Springer Gabler; 2017. DOI: 10.1007/978-3-658-10203-6