Stationäre multimodale Komplextherapie bei Parkinson-Syndrom

Zusammenfassung

Im stationären Versorgungsbereich besteht die Option, aktivierende Therapien bei Parkinson-Patienten als multimodale Komplextherapie im Rahmen des geltenden Fallpauschalen-Systems (DRG) abzubilden. Dies bietet stationär behandelten Patienten die Möglichkeit, parallel zur ärztlich notwendigen neurologischen Behandlung (z. B. Pharmakotherapie, Medikamentenpumpen, Einstellung der tiefen Hirnstimulation) ein interdisziplinäres, hochfrequentes Angebot aktivierender Therapien zu erhalten. Ein wesentlicher Bestandteil ist dabei die Physiotherapie. Symptomspezifische und auf das Krankheitsstadium zugeschnittene Physiotherapie ist nachweislich effektiv, wenn im entsprechenden Kontext und mit hoher Frequenz therapiert wird. Im Folgenden werden drei physiotherapeutische Behandlungsoptionen für funktionell wichtige Probleme vieler Parkinson-Patienten erläutert, die sich aufgrund der hohen Zahl von Einzeltherapien innerhalb der multimodalen Komplextherapie sehr gut realisieren lassen.

Summary

Patients with Parkinson’s disease (PD) who are hospitalized may take advantage of the „multimodal complex therapy”, which is in the catalogue of operational procedures of the German DRG-System. This entails while inpatient an intensive and high frequency exposure to activating therapies (i. e. physio, occupational, psychological, voice, swallowing therapies and possibly others) parallel to the pertinent neurological treatment (pharmacotherapy, medication pumps, optimization of deep brain stimulation parameters). Symptom specific and for the disease stage designed physiotherapy is effective in PD, if the exercises are context specific and are practised with high intensity. Here we describe three physiotherapeutical methods for the treatment of relevant functional deficits of many PD patients, which needs a high number of individualized therapy and can be therefore well organized through this “multimodal complex therapy”.

Schlüsselwörter

Parkinson-Syndrom - multimodale Komplextherapie - Physiotherapie - LSVT™ BIG - AntiFreezing-Training - Sturzprophylaxe

Keywords

Parkinson’s disease - multimodal complex therapy - physiotherapy - LSVT™ BIG - freezing - fall prevention

• Literatur

• 1 Tomlinson CL. et al. Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database Syst Rev 2012; 08: CD002817.
• 2 Keus SH, Bloem BR, Hendriks EJ, Bredero-Cohen AB, Munneke M. Evidence-based analysis of physical therapy in Parkinson’s disease with recommendations for practice and research. Mov Disord 2007; 22 (04) 451-60.
• 3 Berardelli A, Rothwell JC, Thompson PD, Hallett M. Pathophysiology of bradykinesia in Parkinson’s disease. Brain 2001; 124 (Pt 11): 2131-46.
• 4 Morris ME, Iansek R, Matyas TA, Summers JJ. Stride length regulation in Parkinson’s disease. Normalization strategies and underlying mechanisms. Brain 1996; 119 (Pt 2): 551-68.
• 5 Canning CG, Ada L, Johnson JJ, McWhirter S. Walking capacity in mild to moderate Parkinson’s disease. Arch Phys Med Rehabil 2006; 87 (03) 371-5.
• 6 Carr JH, Shepherd RB. Neurological rehabilitation: optimizing motor performance. New York: Churchill Livingstone; 2010
• 7 Rahman S, Griffin HJ, Quinn NP, Jahanshahi M. Quality of life in Parkinson’s disease: the relative importance of the symptoms. Mov Disord 2008; 23 (10) 1428-34.
• 8 Louter M. et al. Subjectively impaired bed mobility in Parkinson disease affects sleep efficiency. Sleep Med. 2013: 3 Mai, E-Pub ahead
• 9 Abbruzzese G, Berardelli A. Sensorimotor integration in movement disorders. Mov Disord 2003; 18 (03) 231-40.
• 10 Fox C, Ebersbach G, Ramig L, Sapir S. LSVT LOUD and LSVT BIG: Behavioral Treatment Programs for Speech and Body Movement in Parkinson Disease. Parkinsons Dis 2012; 2012: 391946.
• 11 Fahn S, Elton R. Unified Parkinsons Disease Rating Scale. In: Fahn S, Marsden C, Goldstein M, Calne D. (Hrsg.). Recent developments in Parkinson’s disease. Florham Park, NJ: 1987
• 12 Keus SH, Nieuwboer A, Bloem BR, Borm GF, Munneke M. Clinimetric analyses of the Modified Parkinson Activity Scale. Parkinsonism & related disorders 2009; 15 (04) 263-9.
• 13 Schädler S. et al. Assessments in der Rehabilitation. 2. Auflage. Bern: Verlag Hans Huber. 2009
• 14 Farley BG, Koshland GF. Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Exp Brain Res 2005; 167 (03) 462-7.
• 15 Ebersbach G. et al. Comparing exercise in Parkinson’s disease – the Berlin LSVT®BIG study. Mov Disord 2010; 25 (12) 1902-8.
• 16 Hely MA, Reid WGJ, Adena MA, Halliday GM, Morris JGL. The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Mov Disord 2008; 23 (06) 837-44.
• 17 Giladi N, Nieuwboer A. Understanding and treating freezing of gait in parkinsonism, proposed working definition, and setting the stage. Mov Disord 2008; 23 (Suppl. 02) S423-5.
• 18 Thompson L, Marsden CD. Freezing. Neurology in clinical practice: principles and diagnosis and management. London: Butterworth-Heinemann; 1995: 321-34.
• 19 Fietzek UM, Zwosta J, Schroeteler FE, Ziegler K, Ceballos-Baumann AO. Levodopa changes the severity of freezing in Parkinson’s disease. Parkinsonism Relat Disord. 2013 1. Mai; E-Pub ahead
• 20 Spildooren J, Vercruysse S, Desloovere K, Vandenberghe W, Kerckhofs E, Nieuwboer A. Freezing of gait in Parkinson’s disease: the impact of dual-tasking and turning. Mov Disord 2010; 25 (15) 2563-70.
• 21 Moore O, Peretz C, Giladi N. Freezing of gait affects quality of life of peoples with Parkinson’s disease beyond its relationships with mobility and gait. Mov Disord 2007; 22 (15) 2192-5.
• 22 Kerr GK, Worringham CJ, Cole MH, Lacherez PF, Wood JM, Silburn PA. Predictors of future falls in Parkinson disease. Neurology 2010; 75 (02) 116-24.
• 23 Paul SS, Canning CG, Sherrington C, Lord SR, Close JCT, Fung VSC. Three simple clinical tests to accurately predict falls in people with Parkinson’s disease. Mov Disord 2013; 28 (05) 655-62.
• 24 Snijders AH, Haaxma CA, Hagen YJ, Munneke M, Bloem BR. Freezer or non-freezer: Clinical assessment of freezing of gait. Parkinsonism Relat Disord 2012; 18 (02) 149-54.
• 25 Giladi N, Shabtai H, Simon ES, Biran S, Tal J, Korczyn AD. Construction of freezing of gait questionnaire for patients with Parkinsonism. Parkinsonism Relat Disord 2000; 06 (03) 165-70.
• 26 Nieuwboer A. et al. Reliability of the new freezing of gait questionnaire: agreement between patients with Parkinson’s disease and their carers. Gait Posture 2009; 30 (04) 459-63.
• 27 Ziegler K, Schroeteler F, Ceballos-Baumann AO, Fietzek UM. A new rating instrument to assess festination and freezing gait in Parkinsonian patients. Mov Disord 2010; 25 (08) 1012-8.
• 28 Mov Disord 2008; 23 (Suppl. 02) S489-94.
• 29 Giladi N. Medical treatment of freezing of gait. Mov Disord 2008; 23 (Suppl. 02) S482-8.
• 30 Martin JP. The basal ganglia and posture. Philadelphia: Lippincott 1967
• 31 Azulay JP, Mesure S, Amblard B, Blin O, Sangla I, Pouget J. Visual control of locomotion in Parkinson’s disease. Brain 1999; 122 (Pt 1): 111-20.
• 32 Schroeteler F, Ziegler K, Fietzek UM, CeballosBaumann A. [Freezing of gait?: Phenomenology, pathophysiology, and therapeutic approaches.]. Der Nervenarzt 2009; 80 (06) 693-9.
• 33 Rahman S, Griffin HJ, Quinn NP, Jahanshahi M. The factors that induce or overcome freezing of gait in Parkinson’s disease. Behavioural neurology 2008; 19 (03) 127-36.
• 34 Ziegler K, Schroeteler F, Fietzek UM. Diagnose und Therapie von Festination und Freezing. Nervenheilkunde 2010; 29: 807-811.
• 35 Melton LJ. et al. Fracture risk after the diagnosis of Parkinson’s disease: Influence of concomitant dementia. Mov Disord 2006; 21 (09) 1361-7.
• 36 Allen NE, Schwarzel AK, Canning CG. Recurrent falls in Parkinson’s disease: a systematic review. Parkinsons Dis 2013; 2013: 906274.
• 37 Ashburn A, Stack E, Ballinger C, Fazakarley L, Fitton C. The circumstances of falls among people with Parkinson’s disease and the use of Falls Diaries to facilitate reporting. Disability and rehabilitation 2008; 30 (16) 1205-12.
• 38 Bhattacharya RK, Dubinsky RM, Lai SM, Dubinsky H. Is there an increased risk of hip fracture in Parkinson’s disease? A nationwide inpatient sample. Mov Disord 2012; 27 (11) 1440-3.
• 39 Spottke AE. et al. Cost of illness and its predictors for Parkinson’s disease in Germany. Pharmacoeconomics 2005; 23 (08) 817-36.
• 40 Woodford H, Walker R. Emergency hospital admissions in idiopathic Parkinson’s disease. Mov Disord 2005; 20 (09) 1104-8.
• 41 Schrag A, Hovris A, Morley D, Quinn N, Jahanshahi M. Caregiver-burden in parkinson’s disease is closely associated with psychiatric symptoms, falls, and disability. Parkinsonism Relat Disord 2006; 12 (01) 35-41.
• 42 Pickering RM. et al. A meta-analysis of six prospective studies of falling in Parkinson’s disease. Mov Disord 2007; 22 (13) 1892-900.
• 43 Latt MD, Lord SR, Morris JGL, Fung VSC. Clinical and physiological assessments for elucidating falls risk in Parkinson’s disease. Mov Disord 2009; 24 (09) 1280-9.
• 44 Matinolli M, Korpelainen JT, Korpelainen R, Sotaniemi KA, Virranniemi M, Myllylä VV. Postural sway and falls in Parkinson’s disease: a regression approach. Mov Disord 2007; 22 (13) 1927-35.
• 45 Mak MKY, Auyeung MM. The mini-BESTest can predict Parkinsonian recurrent fallers: A 6-month prospective study. J Rehabil Med. 2013: 29 April; E-Pub ahead
• 46 Allen NE. et al. The effects of an exercise program on fall risk factors in people with Parkinson’s disease: a randomized controlled trial. Mov Disord 2010; 25 (09) 1217-25.
• 47 Goodwin VA, Richards SH, Henley W, Ewings P, Taylor AH, Campbell JL. An exercise intervention to prevent falls in people with Parkinson’s disease: a pragmatic randomised controlled trial. J Neurol Neurosurg Psychiatr 2011; 82 (11) 1232-8.
• 48 Jöbges M, Heuschkel G, Pretzel C, Illhardt C, Renner C, Hummelsheim H. Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2004; 75 (12) 1682-7.
• 49 Protas EJ, Mitchell K, Williams A, Qureshy H, Caroline K, Lai EC. Gait and step training to reduce falls in Parkinson’s disease. NeuroRehabilitation 2005; 20 (03) 183-90.
• 50 Li F, Harmer P. et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med 2012; 366 (06) 511-9.
• 51 Ramig L. et al. Intensive voice treatment (LSVT) for patients with Parkinson’s disease: a 2 year followup. J Neurol Neurosurg Psychaitry 2001; 71 (04) 493-8.