Diagnostik und Therapie der Gliedmaßenapraxie

 

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Zusammenfassung

Apraxien sind Störungen der höheren motorischen Kognition, die durch basale sensomotorische Defizite nicht hinreichend erklärt werden. Häufige apraktische Symptome sind eine fehlerhafte Imitation abstrakter und symbolischer Gesten sowie Fehler beim Gebrauch von Gegenständen und Werkzeugen. Trotz der Relevanz der Apraxien für die Rehabilitationsbehandlung und ambulante Versorgung von Schlaganfallpatienten werden Apraxien nach wie vor zu selten diagnostiziert und behandelt. In diesem Übersichtsartikel werden die diagnostischen Instrumente zur Feststellung einer Apraxie evaluiert. Zudem werden ein Apraxie-Screening-Instrument und ein diagnostisches Testverfahren für die klinische Anwendung empfohlen. Darüber hinaus werden die publizierten Ansätze zur Apraxie-Therapie dargestellt. Trotz der aktuell noch eingeschränkten Evidenz kann das Gesten-Training von Smania und Mitarbeitern zur Behandlung einer Apraxie empfohlen werden, da bei diesem Training sowohl ein Transfer des Therapieeffekts auf alltagsrelevante Tätigkeiten als auch eine Nachhaltigkeit des Therapieeffekts beobachtet werden konnte. Dieser Übersichtsartikel soll die Aufmerksamkeit auf die Bedeutung der Gliedmaßenapraxie im klinischen Alltag lenken und dem interessierten Leser Instrumente an die Hand geben, mit deren Hilfe Apraxien zuverlässig diagnostiziert und therapiert werden können. Dies sind wichtige Voraussetzungen für die weitere Erforschung der neurobiologischen Grundlagen der Apraxien und die Entwicklung neuer Therapiestrategien für eine evidenzbasierte Behandlung von Apraxien.

Abstract

Apraxia is a disorder of higher motor cognition. Deficits in imitating abstract and symbolic gestures as well as deficits in appropriate tool use are common apraxic symptoms which, importantly, cannot be explained by primary sensorimotor deficits alone. In spite of the relevance of apraxia for neurorehabilitation and the individual stroke patient’s prognosis, apraxia is to date still too rarely diagnosed and treated. In this review the currently published assessments for the diagnosis of apraxia are evaluated. Based on this, an apraxia screening instrument as well as a diagnostic test for clinical use are recommended. In addition, different published approaches to the therapy for apraxia are described. Although current evidence is scarce, the gesture training suggested by Smania and co-workers can be recommended as a therapy for apraxia, because its effects were shown to extend to activities of daily living and to persist for at least two months after completion of the training. This review aims at directing the clinician’s attention to the importance of apraxia. Moreover, it provides the interested reader with instruments for a reliable diagnosis and effective treatment of apraxia. These are also important prerequisites for further research into the neurobiological mechanisms underlying apraxia and the development of new therapy strategies leading to an evidence-based effective treatment of apraxia.

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Anna Dovern

Institut für Neurowissenschaften und Medizin (INM-3), Forschungszentrum Jülich

Leo-Brandt-Str. 5

52425 Jülich

Email: A.Dovern@fz-juelich.de