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Arm und Hand bei der Zerebralparese

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Zusammenfassung

Die Bedeutung der oberen Extremität bei der Zerebralparese ergibt sich durch die mannigfachen Möglichkeiten ihrer Deformierung, die zu progredienten funktionellen und kosmetischen und bei den stärker Behinderten auch zu pflegetechnischen Einbußen führt. Betroffen sind Patienten mit spastischer unilatealer Parese und die stärker Behinderten mit bilateraler Zerebralparese. Bei allen Hemipareseformen ist die frühzeitige konservativkombinierte Behandlung etabliert, wenngleich sich damit nur die leichten Grade funktionell verbessern lassen. Operative Maßnahmen können immer nur die Stellung und die mechanischen Voraussetzungen für den willkürlichen oder musterbedingten Einsatz der Hand verbessern, das zentrale Problem der sensomotorischen Defizite bleibt durch sie unbeeinflusst. Deshalb dürfen diesbezüglich keine zu hohen Erwartungen gestellt werden. Eine kosmetische Stellungsverbesserung ist aber mit vertretbarem Aufwand fast immer erreichbar. Mit realistischen Behandlungszielen können Verbesserungen für den Einsatz als Hilfshand erzielt werden, weshalb die Indikation zu operativen Maßnahmen weiterhin ihre Berechtigung hat. Die Ergebnisse der intensivierten Funktionsschulung sind durchaus ermutigend, wenngleich ihre Nachhaltigkeit limitiert ist. Dennoch tragen sie als wesentliche Ergänzung und Unterstützung des bisherigen konservativen und operativen Behandlungsprogrammes bei.

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  1. Orthopädische Kinderklinik, Behandlungszentrum Aschau GmbH, Orthopädische Kinderklinik, Aschau im Chiemgau, Deutschland

    Leonhard Döderlein

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  1. Leonhard Döderlein
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Döderlein, L. (2015). Arm und Hand bei der Zerebralparese. In: Infantile Zerebralparese. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-35319-2_14

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  • DOI: https://doi.org/10.1007/978-3-642-35319-2_14

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