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Nervenheilkunde 2006; 25(11): 933-940
DOI: 10.1055/s-0038-1626802
Originaler Artikel
Schattauer GmbH

Erholung im motorischen System nach Hirnschädigung

Mechanismen der Erholung und Therapieentwicklung – Initiativen und Ergebnisse aus dem Subnetz „Rehabilitation nach Schlaganfall“ des Kompetenznetzes SchlaganfallMotor system recovery after brain damageMechanisms of recovery and development of restorative therapy – initiatives and results from the rehabilitation subnet of the German competence net stroke
T. Platz
1   NRZ Greifswald gGmbH
,
J. Liepert
2   Klinik für Neurologie, Universitätsklinikum Eppendorf, Hamburg
,
R. J. Seitz
3   Neurologische Klinik, Universitätsklinikum Düsseldorf
4   Biomedizinisches Forschungszentrum Heinrich-Heine-Universität Düsseldorf
5   Brain Imaging Centre West, Jülich
,
C. M. Bütefisch
3   Neurologische Klinik, Universitätsklinikum Düsseldorf
6   Neurologisches Therapiezentrum Düsseldorf
,
K. Müller
3   Neurologische Klinik, Universitätsklinikum Düsseldorf
5   Brain Imaging Centre West, Jülich
6   Neurologisches Therapiezentrum Düsseldorf
,
B. Suchan
6   Neurologisches Therapiezentrum Düsseldorf
,
V. Hömberg
6   Neurologisches Therapiezentrum Düsseldorf
7   St. Mauritius Therapieklinik, Meerbusch
,
C. Weiller
8   Klinik für Neurologie, Universitätsklinikum Freiburg
,
O. Witte
9   Klinik für Neurologie, Universitätsklinikum Jena
› Author Affiliations
Further Information

Publication History

Publication Date:
18 January 2018 (online)

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Zusammenfassung

Mechanismen der Erholung im motorischen System lassen sich unter anderem tierexperimentell untersuchen. Funktionelle Bildgebungsstudien beim Menschen ergänzen diese Befunde und legen nahe, dass das periläsionelle Hirngewebe, das vorübergehend durch eine Ischämie beeinträchtigt worden ist, wieder funktionstragend werden kann. Eine Erhöhung der zerebralen Erregbarkeit tritt aber nicht nur periläsionell, sondern auch in der nicht-betroffenen Hemisphäre auf. Sie ist wahrscheinlich eine weitere Grundlage der postläsionellen Plastizität. Die veränderte zerebrale Erregbarkeit wird auch vom Ort der Schädigung mitbestimmt. Denn umschriebene Hirninfarkte führen zu lokalisationsspezifischen Erregbarkeitsänderungen in räumlich entfernten, aber funktionell verbundenen Hirnarealen. Damit gehen auch unterschiedliche Effekte eines motorischen Trainings auf die zerebrale Erregbarkeit einher. Das verbesserte Verständnis über die Mechanismen der Erholung trägt dazu bei, die rehabilitative Therapie neurowissenschaftlich zu fundieren. Die Entwicklung und Evaluation klinischer motorischer Skalen unterstützt dabei die alltagsnahe Dokumentation von Lähmungsauswirkungen und fördert die Messung von Therapieeffekten. Ein neues Therapiekonzept, dass spezifisch die verschiedenen motorischen Kontrolldefizite bei Lähmungen behandelt (impairment-oriented training – IOT) erwies sich in klinischen Studien als wirksam. Auch pharmakologische Effekte auf Erholung und Trainingseffekte werden geprüft.

Summary

Recovery after brain damage involves various complex mechanisms. The rehabilitation subnet of the German competence net stroke conducts both animal and human studies that promote our understanding of mechanisms of recovery and their modification by therapy. Human brain imaging studies documented the relevance of perilesional brain tissue for functional recovery, an increased cortical excitability in the non-lesioned hemisphere, as well as the modification of changes in cortical excitability and of effects of rehabilitative training by the neuroanatomical location of lesions with specific alterations of excitability in distant functionally connected brain areas. These neuroscience perspectives serve as knowledge base for the development of restorative therapies. The development and evaluation of clinical scales facilitates the clinical documentation of motor deficits and the monitoring of therapeutic effects. Supportive evidence has been provided for new therapeutic concepts such as the impairment-oriented training. In addition, possibilities to enhance recovery by pharmacological interventions have been investigated.

Schlüsselwörter

Schlaganfall - MRI - TMS - Plastizität - Assessment - Training

Keywords

Stroke - MRI,TMS - plasticity - assessment - training
 

  • Literatur

  • 1 Aydin-Abidin S, Moliadze V, Eysel UT, Funke K. Effects of repetitive TMS on visually evoked potentials and EEG in the anesthetized cat: dependence on stimulus frequency and train duration. J Physiol. 2006 Epub ahead of print.
    Google Scholar
  • 2 Binkofski F, Amunts K, Stephan KM, Posse S, Schormann T, Freund HJ, Zilles K, Seitz RJ. Broca’s region subserves imagery of motion: a combined cytoarchitectonic and fMRI study. Hum Brain Mapp 2000; 11: 273-85.
    CrossrefGoogle Scholar
  • 3 Binkofski F, Seitz RJ. Modulation of the BOLDresponse in early recovery from sensorimotor stroke. Neurology 2004; 63: 1223-9.
    CrossrefGoogle Scholar
  • 4 Bütefisch CM, Netz J, Wessling M, Seitz RJ, Hömberg V. Remote changes in cortical excitability after stroke. Brain 2003; 126: 470-81.
    CrossrefGoogle Scholar
  • 5 Bütefisch CM, Kleiser R, Körber B, Müller K, Wittsack H-J, Hömberg V, Seitz RJ. Recruitment of contralesional motor cortex in stroke patients with recovery of hand function. Neurology 2005; 64: 1067-9.
    CrossrefGoogle Scholar
  • 6 Dam M, Tonin P, De Boni A, Pizzolato G, Casson S, Ermani M, Freo U, Piron L, Battistin L. Effects of fluoxetine and maprotiline on functional recovery in poststroke hemiplegic patients undergoing rehabilitation therapy. Stroke 1996; 27: 1211-4.
    CrossrefGoogle Scholar
  • 7 Goldstein LB. Common drugs may influence motor recovery after stroke. Neurology 1995; 45: 865-71.
    CrossrefPubMedGoogle Scholar
  • 8 Hamzei F, Liepert J, Dettmers C, Weiller C, Rijntjes M. Two different reorganization patterns after rehabilitative therapy: an exploratory study with fMRI and TMS. Neuroimage. 2006 im Druck.
    Google Scholar
  • 9 Huemmeke M, Eysel UT, Mittmann T. Lesion-induced enhancement of LTP in rat visual cortex is mediated by NMDA receptors containing the NR2B subunit. J Physiol 2004; 559: 875-82.
    CrossrefGoogle Scholar
  • 10 Jacobs KM, Donoghue JP. Reshaping the cortical motor map by unmasking latent intracortical connections. Science 1991; 251: 944-7.
    CrossrefGoogle Scholar
  • 11 van Kaick S, Platz T. Motorisches Assessment bei zentralen Paresen. Nervenheilkunde 2006; 25: 159-65.
    Article in Thieme ConnectGoogle Scholar
  • 12 Kleiser R, Wittsack H-J, Bütefisch CM, Jörgens S, Seitz RJ. Functional activation within the PI-DWI mismatch region in recovery from hemiparetic stroke: preliminary observations. Neuroimage 2005; 24: 515-23.
    CrossrefGoogle Scholar
  • 13 Kluska MM, Witte OW, Bolz J, Redecker C. Neurogenesis in the adult dentate gyrus after cortical infarcts: effects of infarct location, N-methylD-aspartate receptor blockade and anti-inflammatory treatment. Neuroscience 2005; 135: 723-35.
    CrossrefGoogle Scholar
  • 14 Kraemer M, Schormann T, Hagemann G, Bi Q, Witte OW, Seitz RJ. Delayed shrinkage of the brain after ischemic stroke: Preliminary Observations with Voxel-Guided Morphometry. J Neuroimaging 2004; 14: 265-72.
    CrossrefGoogle Scholar
  • 15 Liepert J, Gorsler A, van Eimeren T, Münchau A, Weiller C. Motor excitability in a patient with a somatosensory cortex lesion. Clin Neurophysiol 2003; 114: 1003-8.
    CrossrefGoogle Scholar
  • 16 Liepert J, Kucinski T, Tüscher O, Pawlas F, Bäumer T, Weiller C. Motor cortex excitability after cerebellar infarction. Stroke 2004; 35: 2484-8.
    CrossrefGoogle Scholar
  • 17 Liepert J, Restemeyer C, Münchau A, Weiller C. Motor cortex excitability after thalamic infarction. Clin Neurophysiol 2005; 116: 1621-7.
    CrossrefGoogle Scholar
  • 18 Liepert J, Restemeyer C, Kucinski T, Zittel S, Weiller C. Motor strokes: The lesion location determines motor excitability changes. Stroke 2005; 36: 2648-53.
    CrossrefGoogle Scholar
  • 19 Liepert J. Motor cortex excitability in stroke before and after Constraint-induced movement therapy. J Cogn Behav Neurol. 2006 im Druck.
    Google Scholar
  • 20 Nudo RJ, Wise BM, SiFuentes F, Milliken GW. Neural substrates for the effects of rehabilitative training on motor recovery after ischemic infarct. Science 1996; 272: 1791-4.
    CrossrefGoogle Scholar
  • 21 Nudo RJ, Milliken GW. Reorganisation of movement representations in primary motor cortex following focal ischemic infarcts in adult squirrel monkeys. J Neurophysiol 1996; 75: 2144-9.
    CrossrefGoogle Scholar
  • 22 Platz T, Bock S, Prass K. Reduced skilfulness of arm motor behaviour among motor stroke patients with good clinical recovery: Does it indicate reduced automaticity ? Can it be improved by unilateral or bilateral training ?A kinematic motion analysis study. Neuropsychologia 2001; 39: 687-98.
    CrossrefGoogle Scholar
  • 23 Platz T, Winter T, Müller N, Pinkowski C, Eickhof C, Mauritz K-H. Arm Ability Training for Stroke and Traumatic Brain Injury Patients with mild arm paresis. A Single-Blind, Randomized, Controlled Trial. Archives of Physical Medicine and Rehabilitation 2001; 82: 961-8.
    CrossrefGoogle Scholar
  • 24 Platz T. Charakterisierung motorischer Defizite und Prädiktion des Therapieerfolges mittels Bewegungsanalyse und Analyse bewegungskorrelierter Potenziale (multimodales EEG). Klin Neurophysiol 2002; 33: 1-11.
    Article in Thieme ConnectGoogle Scholar
  • 25 Platz T. (guest editor). Motor System Plasticity, Recovery and Rehabilitation (special issue). Restorative Neurology and Neuroscience 2002; 22: 137-398.
    Google Scholar
  • 26 Platz T. Impairment-oriented Training (IOT) - scientific concept and evidence-based treatment strategies. Restorative Neurology and Neuroscience 2004; 22: 301-15.
    PubMedGoogle Scholar
  • 27 Platz T. Apraxie - Neurowissenschaft und Klinik. Nervenarzt 2005; 76: 1209-21. online publication http://dx.doi.org/10.1007/s00115–005–1936–3
    CrossrefGoogle Scholar
  • 28 Platz T, Pinkowski C, van Wijck F, Kim IH, di Bella P, Johnson G. Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study. Clinical Rehabilitation 2005; 19: 404-11.
    CrossrefGoogle Scholar
  • 29 Platz T, Eickhof C, Nuyens G, Vuadens P. Clinical scales fort he assessment of spasticity, associated phenomena, and function: a systematic review of the literature. Disability and Rehabilitation 2005; 27: 7-18.
    CrossrefGoogle Scholar
  • 30 Platz T, Pinkowski C, van Wijck F, Johnson G. ARM. Arm Rehabilitation Measurement, Manual for performance and scoring. Baden-Baden: Deutscher Wissenschafts-Verlag; 2005
    Google Scholar
  • 31 Platz T, Eickhof C, van Kaick S, Engel U, Pinkowski C, Kalok S, Pause M. Impairment-oriented training or Bobath therapy for arm paresis after stroke: a single blind, multi-centre randomized controlled trial. Clin Rehabil 2005; 19: 714-24.
    CrossrefGoogle Scholar
  • 32 Platz T, van Kaick S, Möller L, Freund S, Winter T, Kim I-H. Impairment-oriented training and adaptive motor cortex reorganisation after stroke: a fTMS study. J Neurol. 2005 online publication at http://dx.doi.org/10.1007/s00415–005–0868-y
    Google Scholar
  • 33 Platz T, Kim I-H, Engel U, Pinkowski C, Eickhof C, Kutzner M. Amphetamine fails to facilitate motor performance and to enhance motor recovery among stroke patients with mild arm paresis: interim analysis and termination of a double blind, randomised, placebo-controlled trial. Restorative Neurology and Neuroscience 2005; 23: 271-80.
    Google Scholar
  • 34 Platz T. IOT Impairment-Oriented Training. Schädigungs-orientiertes Training. Theorie und deutschsprachige Manuale für Therapie und Assessment. Arm-BASIS-Training, Arm-Fähigkeits-Training, Fugl-Meyer test (Arm), TEMPA. Baden-Baden: Deutscher Wissenschafts-Verlag; 2006
    Google Scholar
  • 35 Reinecke S, Dinse HR, Reinke H, Witte OW. Induction of bilateral plasticity in sensory cortical maps by small unilateral cortical infarcts in rats. Eur J Neurosci 2003; 17: 623-7.
    CrossrefGoogle Scholar
  • 36 Restemeyer C, Weiller C, Liepert J. L-Dopa in der Neuro-Rehabilitation. Eine randomisierte, placebo-kontrollierte, doppelblinde Studie. Akt Neurol 2005; 32 (Abstract).
    Google Scholar
  • 37 Scheidtmann K, Fries W, Muller F, Koenig E. Effect of levodopa in combination with physiotherapy on functional motor recovery after stroke: a prospective, randomised, double-blind study. Lancet 2001; 358: 787-90.
    CrossrefPubMedGoogle Scholar
  • 38 Seitz RJ, Knorr U, Azari NP. Weder Cerebral networks in sensorimotor distrubances. Brain Res Bulletin 2001; 54: 299-305.
    CrossrefGoogle Scholar
  • 39 Seitz RJ, Hamzavi M, Junghans U, Ringleb PA, Schranz C, Siebler M. Thrombolysis with recombinant tissue plasminogen activator and Tirofiban in stroke. Preliminary observations. Stroke 2003; 34: 1932-5.
    CrossrefGoogle Scholar
  • 40 Seitz RJ, Meisel S, Moll M, Wittsack H-J, Junghans U, Siebler M. The effect of combined thrombolysis with rtPA and Tirofiban on ischemic brain lesions. Neurology 2004; 62: 210-2.
    Google Scholar
  • 41 Seitz RJ, Bütefisch CM, Kleiser R, Hömberg V. Reorganization of cerebral circuits in human ischemic brain disease. Restorative Neurol Neurosci 2004; 22: 207-29.
    Google Scholar
  • 42 Seitz RJ, Kleiser R, Bütefisch CM, Jörgens S, Neuhaus O, Hartung H-P, Wittsack H-J, Sturm V, Hermann MM. Bimanual recoupling by visual cueing in callosal disconnection. Neurocase 2004; 10: 316-25.
    CrossrefGoogle Scholar
  • 43 Seitz RJ, Meisel S, Weller P, Junghans U, Wittsack H-J, Siebler M. The initial ischemic event: PWI and ADC for stroke evolution. Radiology 2005; 237: 1020-8.
    CrossrefGoogle Scholar
  • 44 Seitz RJ, Meisel S, Moll M, Wittsack H-J, Junghans U, Siebler M. Partial rescue of the perfusion deficit area by thrombolysis. J Magnet Res Imaging 2005; 22: 199-205.
    Google Scholar
  • 45 Shanina EV, Schallert T, Witte OW, Redecker C. Behavioral recovery from unilateral photothrombotic infarcts of the forelimb sensorimotor cortex in rats: Role of the contralateral cortex. Neuroscience 2006; 139: 1495-506.
    CrossrefGoogle Scholar
  • 46 Stephan KM, Thaut MH, Wunderlich G, Schicks W, Tian B, Tellmann L, Schmitz T, Herzog H, McIntosh GC, Seitz RJ, Hömberg V. Conscious and subconscious sensorimotor synchronization – prefrontal cortex and the influence of awareness. Neuroimage 2002; 15: 345-52.
    CrossrefGoogle Scholar
  • 47 Suchan B, Yaguez L, Wunderlich G, Canavan AG, Herzog H, Tellmann L, Homberg V, Seitz RJ. Neural correlates of visuospatial imagery. Behav Brain Res 2002; 131: 163-8.
    CrossrefGoogle Scholar
  • 48 Suchan B, Yaguez L, Wunderlich G, Canavan AG, Herzog H, Tellmann L, Homberg V, Seitz RJ. Hemispheric dissociation of visual-pattern processing and visual rotation. Behav Brain Res 2002; 136: 533-44.
    CrossrefGoogle Scholar
  • 49 Suchan B, Melde C, Hömberg V, Seitz RJ. Cingulate cortex activation and competing responsees: the role of preparedness for competition. Behav Brain Res 2005; 163: 219-26.
    CrossrefGoogle Scholar
  • 50 Suchan B, Melde C, Herzog H, Hömberg V, Seitz RJ. Observation of hand movements for imitation or velocity judgement: The “where” and “what” in action processing. Eingereicht.
    Google Scholar
  • 51 Weller P, Wittsack H-J, Siebler M, Hömberg V, Seitz RJ. Motor recovery as assessed with isometric finger movements and perfusion MRI after acute ischemic stroke. NNR. Im Druck.
    Google Scholar
  • 52 Witte OW. Lesion-induced plasticity asa potential mechanism for recovery and rehabilitative training. Curr Opin Neurol 1998; 11: 655-62.
    CrossrefGoogle Scholar
  • 53 Wunderlich G, Suchan B, Volkmann J, Herzog H, Hömberg V, Seitz RJ. Visual hallucinations in recovery from cortical blindness: imaging correlates. Arch Neurol 2000; 57: 561-5.
    CrossrefGoogle Scholar
  • 54 Zittel S, Weiller C, Liepert J. Reboxetine improves motor function in chronic stroke. Eingereicht.
    Google Scholar