Therapeutischer Effekt Sensor-gestützter Rehabilitationssysteme bei Schlaganfallpatienten

 

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Zusammenfassung

Hintergrund: Steigende Lebenserwartung im Kontext des demografischen Wandels sowie entwickelte Diagnose- und Versorgungsstrukturen führen zu abnehmenden Inzidenz- und Mortalitätsraten, gleichzeitig jedoch zu höherer Prävalenz des Schlaganfalls in westlichen Industrienationen. Aktuelle Entwicklungen von Sensor-basierten Rehabilitationssystemen dienen als Ergänzung zu konventionellen Verfahren. Die Erfassung von Bewegungsdaten sowie die Verarbeitung und Ausgabe der Daten als Nutzerfeedback ermöglichen die Konzeption neuer, motivierender Schlaganfall-Therapiekonzepte.

Ziel der Arbeit: Dieser Übersichtsartikel untersucht Sensor-gestützte Rehabilitationssysteme bezüglich ihres therapeutischen Effekts bei Schlaganfallpatienten. Darüber hinaus sollen die differente Systemarchitektur sowie deren Zielstellung vorgestellt werden. Dabei finden Interventionsdauer sowie Häufigkeit und Länge der Trainingseinheiten Berücksichtigung.

Methoden: Nach Literaturrecherche wurden 10 Systeme eingeschlossen und differenziert analysiert. Der Effekt wurde über das modifizierte Cohen’s d operationalisiert und zudem in prozentualer Relation zum maximalen Assessment Score sowie zum Ausgangswert berechnet.

Ergebnisse: Die Erfassung von Bewegungsdaten erfolgt mit Inertialsensoren, optoelektronischen Systemen sowie 3D-Magnetometern. Im Mittel wurden 14±5,75 Probanden im Alter von 58,55±5,8 Jahren untersucht. Die Patienten waren 467,05±570,39 Tage post-stroke und trainierten über einen Zeitraum von 4,75±3,23 Wochen, in 4,3±0,82 Einheiten pro Woche für jeweils 48±29,83 min. Es konnten kleine bis sehr große Effekte (dmod=0,22–5,88) festgestellt werden.

Diskussion: Schlaganfallpatienten profitieren in unterschiedlichen Phasen nach Apoplex vom jeweiligen Rehabilitationssystem. Es kann kein klarer Ursache-Wirkung Zusammenhang zwischen Dauer der Intervention sowie der Trainingseinheit und dem therapeutischen Effekt festgestellt werden. Systematische Untersuchungsansätze hinsichtlich der optimalen Belastungsdosierung beim jeweiligen Patientenkollektiv stehen noch aus. Klinisch relevante motorische Funktionseinschränkungen bestehen noch Jahre nach dem Insult, was den langfristigen Therapiebedarf im häuslichen Umfeld unterstreicht. Aus den Ergebnissen ergeben sich erste Ansätze zur Beurteilung der Eignung der Sensor-gestützten Schlaganfallrehabilitation.

Abstract

Background: The increase of average life expectancy in the course of demographic change, as well as further developed methods of diagnosis and medical care are leading to decreasing rates of incidence and mortality but simultaneously to an increasing prevalence of stroke in western industrial nations. Current developments of sensor-based rehabilitation systems supplement conventional therapy. Measuring motion data and processing the information to give feedback to the user allow the conception of new, motivating stroke therapy concepts.

Objective: The aim of this review article is to analyze sensor-based rehabilitation systems regarding their therapeutic effect on stroke patients. Furthermore, different system goals and architectures are introduced. Thereby the length and frequency of the training sessions are taken into consideration, as well as the overall duration of the intervention.

Methods: After analyzing the literature, 10 systems were included and investigated. The effect was operationalized with the modified Cohen’s d and was calculated in propotional relation to the maximal assessment score as well as to baseline.

Results: Motion data was recorded using inertial sensors, optoelectronic systems and 3-dimensional magnetometers. On average, 14±5.75 subjects aged 58.55±5.8 years were investigated. The patients were 467.05±570.39 days post-stroke and trained over a period of 4.75±3.23 weeks on 4.3±0.82 sessions per week lasting 48±29.83 min each. Small to very large effects (dmod=0.22–5.88) were documented.

Conclusions: Stroke patients at different stages post-stroke benefit from the respective rehabilitation systems. No clear cause and effect was found between the length of the intervention or training session and the therapeutic effect. Systematic explorations regarding the optimal dose of stress for the respective patient population are still pending. There are persisting motor function deficits of clinical relevance years after the stroke which emphasizes the demand for long-term therapy in the home environment. The results give first indications for evaluating the aptitude of sensor-based stroke rehabilitation.

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