Aktivierende Therapie bei Morbus Parkinson

Zusammenfassung

Bei den meisten Patienten mit Parkinson-Erkrankung kommt es durch die im langfristigen Verlauf auftretenden Störungen der Sprech- und Schluckfunktionen, der Körperhaltung, des Gehens und des Gleichgewichts trotz medikamentöser (und chirurgischer) Therapie zu starken Behinderungen und negativen Auswirkungen auf die Lebensqualität. Physiotherapie, Ergotherapie, Logopädie und andere aktivierende Therapieverfahren werden schon seit langer Zeit auf weitgehend empirischer Basis angewendet, um den pharmakoresistenten motorischen Störungen entgegenzuwirken. In den letzten Jahren wurde die Wirksamkeit der aktivierenden Therapien zunehmend durch methodisch hochwertige Studien untermauert. Zusätzlich haben Untersuchungen am Tiermodell der Parkinson-Erkrankung Hinweise erbracht, dass körperliche Aktivität neben den unmittelbaren Trainingseffekten auch positive Auswirkungen auf neurodegenerative Prozesse und den Krankheitsverlauf haben könnte. Ziel dieses Übersichtartikels ist es, den Stellenwert der aktivierenden Therapie im Management der Parkinson-Erkrankung darzustellen.

Abstract

Long-term complications of Parkinson’s disease (PD) including impairments of speech, swallowing, posture, gait and balance are associated with significant disability. Even with optimal pharmacological (and surgical) interventions, these deficits cannot be controlled satisfactorily in the majority of patients, resulting in a negative impact on quality of life. Rehabilitative measures including physiotherapy, speech training and occupational therapy are often implemented on an empirical basis to counteract the progressive pharmaco-resistant motor disturbances. Studies meeting high methodological standards have been published on this field in recent years, making rehabilitative therapy more evidence-based. In addition, basic science research in animal models of PD has documented the value of exercise for improving motor performance and potentially slowing progression of motor symptoms and neural degeneration. The present article reviews the role of exercise and rehabilitation in the management of PD.

Schlüsselwörter

Parkinson - Physiotherapie - Ergotherapie - Rehabilitation - aktivierende Therapie

Keywords

Parkinson’s disease - physiotherapy - occupational therapy - rehabilitation - exercise

• Literatur

• 1 Bloem BR, Grimbergen YA, Cramer M et al. Prospective assessment of falls in Parkinson’s disease. J Neurol 2001; 248: 950-958
• 2 Hely MA, Morris JG, Reid WG et al. Sydney Multicenter Study of Parkinson’s disease: non-L-dopa-responsive problems dominate at 15 years. Mov Disord 2005; 20: 190-199
• 3 Ceballos-Baumann AO, Ebersbach G. Aktivierende Therapie bei Parkinson-Syndromen. 2.. Aufl., Stuttgart: 2013
• 4 Marsden CD. The mysterious motor function of the basal ganglia: the Robert Wartenberg Lecture. Neurology 1982; 32: 514-539
• 5 Brotchie P, Iansek R, Horne MK. Motor function of the monkey globus pallidus. 1. Neuronal discharge and parameters of movement. Brain 1991; 114: 1667-1683
• 6 Bronstein AM, Yardley L, Moore AP et al. Visually and posturally mediated tilt illusion in Parkinson’s disease and in labyrinthine defective subjects. Neurology 1996; 47: 651-656
• 7 Abbruzzese G, Berardelli A. Sensorimotor integration in movement disorders. Mov Disord 2003; 18: 231-240
• 8 Klockgether T, Borutta M, Rapp H et al. A defect of kinesthesia in Parkinson’s disease. Mov Disord 1995; 10: 460-465
• 9 Moore AP. Impaired sensorimotor integration in parkinsonism and dyskinesia: a role for corollary discharges?. J Neurol Neurosurg Psychiatry 1987; 50: 544-552
• 10 Demirci M, Grill S, McShane L, Hallelett M. A mismatch between kinaesthetic and visual perception in Parkinson’s disease. Ann Neural 1997; 41: 781-788
• 11 Fellows SJ, Noth J, Schwarz M. Precision grip and Parkinson’s disease. Brain 1998; 121: 1771-1784
• 12 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
• 13 Morris ME, Iansek R, Matyas TA et al. Stride length regulation in Parkinson’s disease. Normalization strategies and underlying mechanisms. Brain 1996; 119: 551-568
• 14 Frank MJ, Seeberger LC, O’reilly RC. By carrot or by stick: cognitive reinforcement learning in parkinsonism. Science 2004; 306: 1940-1943
• 15 Hausdorff JM, Doniger GM, Springer S et al. A common cognitive profile in elderly fallers and in patients with Parkinson’s disease: the prominence of impaired executive function and attention. Exp Aging Res 2006; 32: 411-429
• 16 Abbruzzese G, Trompetto C, Marinelli L. The rationale for motor learning in Parkinson’s disease. Eur J Phys Rehabil Med 2009; 45: 209-214
• 17 Leroi I, Ahearn DJ, Andrews M et al. Behavioural disorders, disability and quality of life in Parkinson’s disease. Age Ageing 2011; 40: 614-621
• 18 Saez-Francas N, Hernandez-Vara J, Corominas RM et al. The association of apathy with central fatigue perception in patients with Parkinson’s disease. Behav Neurosci 2013; 127: 237-244
• 19 Abrantes AM, Friedman JH, Brown RA et al. Physical activity and neuropsychiatric symptoms of Parkinson disease. J Geriatr Psychiatry Neurol 2012; 25: 138-145
• 20 Farley BG, Fox CM, Ramig L et al. Intensive amplitude-specific therapeutic approaches for Parkinson’s disease. Topics Ger Rehabil 2008; 24: 99-114
• 21 Platz T, Brown RG, Marsden CD. Training improves the speed of aimed movements in Parkinson’s disease. Brain 1998; 121: 505-514
• 22 Jobges 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
• 23 Hirsch MA, Toole T, Maitland CG et al. 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
• 24 Frenkel-Toledo S, Giladi N, Peretz C et al. Treadmill walking as an external pacemaker to improve gait rhythm and stability in Parkinson’s disease. Mov Disord 2005; 20: 1109-1114
• 25 Pohl M, Rockstroh G, Ruckriem S et al. Immediate effects of speed-dependent treadmill training on gait parameters in early Parkinson’s disease. Arch Phys Med Rehabil 2003; 84: 1760-1766
• 26 Miyai I, Fujimoto Y, Yamamoto H et al. Long-term effect of body weight-supported treadmill training in Parkinson’s disease: a randomized controlled trial. Arch Phys Med Rehabil 2002; 83: 1370-1373
• 27 Ebersbach G, Ebersbach A, Edler D et al. Comparing exercise in Parkinson’s disease – the Berlin LSVT(R)BIG study. Mov Disord 2010; 25: 1902-1908
• 28 Morris ME, Iansek R, Kirkwood B. A randomized controlled trial of movement strategies compared with exercise for people with Parkinson’s disease. Mov Disord 2009; 24: 64-71
• 29 Ford MP, Malone LA, Nyikos I et al. Gait training with progressive external auditory cueing in persons with Parkinson’s disease. Arch Phys Med Rehabil 2010; 91: 1255-1261
• 30 Lee SJ, Yoo JY, Ryu JS et al. The effects of visual and auditory cues on freezing of gait in patients with Parkinson disease. Am J Phys Med Rehabil 2012; 91: 2-11
• 31 Rochester L, Baker K, Nieuwboer A et al. Targeting dopa-sensitive and dopa-resistant gait dysfunction in Parkinson’s disease: selective responses to internal and external cues. Mov Disord 2011; 26: 430-435
• 32 Mak M, Hallett M. Effect of cued training on motor evoked potential and cortical silent period in people with Parkinson’s disease. Clin Neurophysiol 2013; 124: 545-550
• 33 Van Gerpen JA. The utility of laser-generated visual-cueing in parkinsonian patients with gait freezing. Parkinsonism Relat Disord 2012; 18: 400
• 34 Keus SH, Munneke M, Nijkrake MJ et al. Physical therapy in Parkinson’s disease: evolution and future challenges. Mov Disord 2009; 24: 1-14
• 35 Hirsch MA, Farley BG. Exercise and neuroplasticity in persons living with Parkinson’s disease. Eur J Phys Rehabil Med 2009; 45: 215-229
• 36 Tillerson JL, Miller GW. Forced limb-use and recovery following brain injury. Neuroscientist 2002; 8: 574-585
• 37 Ramig LO, Sapir S, Countryman S et al. Intensive voice treatment (LSVT) for patients with Parkinson’s disease: a 2 year follow up. J Neurol Neurosurg Psychiatry 2001; 71: 493-498
• 38 Spielman JL, Borod JC, Ramig LO. The effects of intensive voice treatment on facial expressiveness in Parkinson disease: preliminary data. Cogn Behav Neurol 2003; 16: 177-188
• 39 Snijders AH, Nonnekes J, Bloem BR. Recent advances in the assessment and treatment of falls in Parkinson’s disease. F1000 Med Rep 2010; 2: 76
• 40 Hely MA, Reid WG, Adena MA et al. The Sydney multicenter study of Parkinson’s disease: the inevitability of dementia at 20 years. Mov Disord 2008; 23: 837-844
• 41 Yogev-Seligmann G, Giladi N, Brozgol M et al. A training program to improve gait while dual tasking in patients with Parkinson’s disease: a pilot study. Arch Phys Med Rehabil 2012; 93: 176-181
• 42 Allen NE, Sherrington C, Paul SS et al. Balance and falls in Parkinson’s disease: a meta-analysis of the effect of exercise and motor training. Mov Disord 2011; 26: 1605-1615
• 43 Goodwin VA, Richards SH, Henley W et al. An exercise intervention to prevent falls in people with Parkinson’s disease: a pragmatic randomised controlled trial. J Neurol Neurosurg Psychiatry 2011; 82: 1232-1238
• 44 Li F, Harmer P, Fitzgerald K et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med 2012; 366: 511-519
• 45 Nieuwboer A, Giladi N. Characterizing freezing of gait in Parkinson’s disease: Models of an episodic phenomenon. Mov Disord 2013; 28: 1509-1519
• 46 Espay AJ, Fasano A, van Nuenen BF et al. „On“ state freezing of gait in Parkinson disease: a paradoxical levodopa-induced complication. Neurology 2012; 78: 454-457
• 47 Willems AM, Nieuwboer A, Chavret F et al. The use of rhythmic auditory cues to influence gait in patients with Parkinson’s disease, the differential effect for freezers and non-freezers, an explorative study. Disabil Rehabil 2006; 28: 721-728
• 48 Nieuwboer A, Kwakkel G, Rochester L et al. Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial. J Neurol Neurosurg Psychiatry 2007; 78: 134-140
• 49 Bartolo M, Serrao M, Tassorelli C et al. Four-week trunk-specific rehabilitation treatment improves lateral trunk flexion in Parkinson’s disease. Mov Disord 2010; 25: 325-331
• 50 Schroeteler FE, Fietzek UM, Ziegler K et al. Upright posture in parkinsonian camptocormia using a high-frame walker with forearm support. Mov Disord 2011; 26: 1560-1561
• 51 Robichaud JA, Pfann KD, Vaillancourt DE et al. Force control and disease severity in Parkinson’s disease. Mov Disord 2005; 20: 441-450
• 52 Ebersbach G, Sojer M, Valldeoriola F et al. Comparative analysis of gait in Parkinson’s disease, cerebellar ataxia and subcortical arteriosclerotic encephalopathy. Brain 1999; 122: 1349-1355
• 53 van Nimwegen M, Speelman AD, Hofman-van Rossum EJ et al. Physical inactivity in Parkinson’s disease. J Neurol 2011; 258: 2214-2221
• 54 Dibble LE, Hale TF, Marcus RL et al. High intensity eccentric resistance training decreases bradykinesia and improves Quality Of Life in persons with Parkinson’s disease: a preliminary study. Parkinsonism Relat Disord 2009; 15: 752-757
• 55 Lautenschlager NT, Cox KL, Flicker L et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 2008; 300: 1027-1037
• 56 Petzinger GM, Fisher BE, McEwen S et al. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. Lancet Neurol 2013; 12: 716-726
• 57 Cruise KE, Bucks RS, Loftus AM et al. Exercise and Parkinson’s: benefits for cognition and quality of life. Acta Neurol Scand 2011; 123: 13-19
• 58 Ebersbach G, Ebersbach A, Gandor F et al. Impact of physical exercise on reaction time in patients with parkinson’s disease-data from the Berlin BIG study. Arch Phys Med Rehabil 2014; 95: 996-999
• 59 Ahlskog JE. Does vigorous exercise have a neuroprotective effect in Parkinson disease?. Neurology 2011; 77: 288-294
• 60 Gerecke KM, Jiao Y, Pani A et al. Exercise protects against MPTP-induced neurotoxicity in mice. Brain Res 2010; 1341: 72-83
• 61 Tajiri N, Yasuhara T, Shingo T et al. Exercise exerts neuroprotective effects on Parkinson’s disease model of rats. Brain Res 2010; 1310: 200-207
• 62 Tillerson JL, Caudle WM, Reveron ME et al. Exercise induces behavioral recovery and attenuates neurochemical deficits in rodent models of Parkinson’s disease. Neuroscience 2003; 119: 899-911
• 63 Wu SY, Wang TF, Yu L et al. Running exercise protects the substantia nigra dopaminergic neurons against inflammation-induced degeneration via the activation of BDNF signaling pathway. Brain Behav Immun 2011; 25: 135-146
• 64 Vučković MG, Li Q, Fisher B et al. Exercise elevates dopamine D2 receptor in a mouse model of Parkinson’s disease: in vivo imaging with [(1)(8)F]fallypride. Mov Disord 2010; 25: 2777-2784
• 65 Xu Q, Park Y, Huang X et al. Physical activities and future risk of Parkinson disease. Neurology 2010; 75: 341-348
• 66 Chen H, Zhang SM, Schwarzschild MA et al. Physical activity and the risk of Parkinson disease. Neurology 2005; 64: 664-669
• 67 Thacker EL, Chen H, Patel AV et al. Recreational physical activity and risk of Parkinson’s disease. Mov Disord 2008; 23: 69-74
• 68 Logroscino G, Sesso HD, Paffenbarger Jr RS et al. Physical activity and risk of Parkinson’s disease: a prospective cohort study. J Neurol Neurosurg Psychiatry 2006; 77: 1318-1322
• 69 Goodwin VA, Richards SH, Taylor RS et al. The effectiveness of exercise interventions for people with Parkinson’s disease: a systematic review and meta-analysis. Mov Disord 2008; 23: 631-640
• 70 Tomlinson CL, Patel S, Meek C et al. Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis. BMJ 2012; 345: e5004
• 71 Fox SH, Katzenschlager R, Lim SY et al. The Movement Disorder Society Evidence-Based Medicine Review Update: Treatments for the motor symptoms of Parkinson’s disease. Mov Disord 2011; 26 (Suppl. 03) S2-41
• 72 Tomlinson CL, Patel S, Meek C et al. Physiotherapy versus placebo or no intervention in Parkinson’s disease. Cochrane Database Syst Rev 2012; 8 CD002817
• 73 Tickle-Degnen L, Ellis T, Saint-Hilaire MH et al. Self-management rehabilitation and health-related quality of life in Parkinson’s disease: a randomized controlled trial. Mov Disord 2010; 25: 194-204
• 74 Carda S, Invernizzi M, Baricich A et al. Robotic gait training is not superior to conventional treadmill training in parkinson disease: a single-blind randomized controlled trial. Neurorehabil Neural Repair 2012; 26: 1027-1034
• 75 Dibble LE, Hale T, Marcus RL et al. The safety and feasibility of high-force eccentric resistance exercise in persons with Parkinson’s disease. Arch Phys Med Rehabil 2006; 87: 1280-1282
• 76 Craig LH, Svircev A, Haber M et al. Controlled pilot study of the effects of neuromuscular therapy in patients with Parkinson’s disease. Mov Disord 2006; 21: 2127-2133
• 77 Ebersbach G, Edler D, Kaufhold O et al. Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson’s disease. Arch Phys Med Rehabil 2008; 89: 399-403
• 78 Frazzitta G, Maestri R, Uccellini D et al. Rehabilitation treatment of gait in patients with Parkinson’s disease with freezing: a comparison between two physical therapy protocols using visual and auditory cues with or without treadmill training. Mov Disord 2009; 24: 1139-1143
• 79 Hackney ME, Kantorovich S, Levin R et al. Effects of tango on functional mobility in Parkinson’s disease: a preliminary study. J Neurol Phys Ther 2007; 31: 173-179
• 80 Hackney ME, Earhart GM. Effects of dance on gait and balance in Parkinson’s disease: a comparison of partnered and nonpartnered dance movement. Neurorehabil Neural Repair 2010; 24: 384-392
• 81 Pelosin E, Avanzino L, Bove M et al. Action observation improves freezing of gait in patients with Parkinson’s disease. Neurorehabil Neural Repair 2010; 24: 746-752
• 82 Picelli A, Melotti C, Origano F et al. Robot-assisted gait training in patients with Parkinson disease: a randomized controlled trial. Neurorehabil Neural Repair 2012; 26: 353-361
• 83 Schenkman M, Hall DA, Baron AE et al. Exercise for people in early- or mid-stage Parkinson disease: a 16-month randomized controlled trial. Phys Ther 2012; 92: 1395-1410
• 84 Shulman LM, Katzel LI, Ivey FM et al. Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. JAMA Neurol 2013; 70: 183-190
• 85 Smania N, Corato E, Tinazzi M et al. Effect of balance training on postural instability in patients with idiopathic Parkinson’s disease. Neurorehabil Neural Repair 2010; 24: 826-834
• 86 Yang YR, Lee YY, Cheng SJ et al. Downhill walking training in individuals with Parkinson’s disease: a randomized controlled trial. Am J Phys Med Rehabil 2010; 89: 706-714