Eine vergleichende biomechanische Ganganalyse zwischen dem Idiopathischen Parkinson-Syndrom und dem Normaldruckhydrozephalus

Zusammenfassung

Einleitung:

Die klinische Differenzialdiagnostik von hypokinetischen Gangstörungen kann für den Neurologen in frühen Erkrankungsstadien zu Unsicherheiten führen. Inwieweit der Einsatz von biomechanischen Ganganalysesystemen den Kliniker in seiner Beurteilung unterstützen kann, wurde noch nicht ausreichend geklärt. Das Ziel dieser Studie ist, mithilfe von biomechanischen Messmethoden die Gangmotorik zwischen idiopathischen Parkinson Patienten (IPS) und Normaldruckhydrozephalus Patienten (NDH) objektiv zu vergleichen.

Patienten und Methode:

Eine apparative Ganganalyse wurde von IPS (n=18), NDH (n=18) und einer alters,- gewichts- und größenkonformer Kontrollgruppe (K, n=18) während selbst gewählten Ganggeschwindigkeit unter Laborbedingung durchgeführt. Zur Analyse der biomechanischen Daten wurde SIMI^® Motion 3D Kinematik und eine Fußdruckmessung NOVEL^® Pedar eingesetzt. Als statisches Prüfverfahren wurde eine einfaktorielle Varianzanalyse mit anschließendem post-hoc Test Scheffé angewendet.

Ergebnisse:

Die spezifischen Gangparameter der IPS Patienten (Hoehn und Yahr<2,5, “on“ state) zeigten signifikant reduzierte Schulteramplituden mit erhöhten Armabduktionswinkeln. Die Ganggeschwindigkeit, Schrittlänge, Schrittanzahl, Schrittbreite, Schritthöhe sowie die Fußdruckbelastungen waren nur moderat reduziert gegenüber der K Gruppe (nicht signifikant). NDH Patienten zeigen im Vergleich zur IPS und K einen signifikant breitbasigen Gang mit verkürzter Schrittlänge bei einer erhöhten Schrittanzahl und erhöhten Armabduk­tionswinkel. Die Belastungscharakteristik in der Auftritts-, Stütz- und Abstoßphase war bei der NDH Gruppe am höchsten (ns).

Schlussfolgerung:

Unsere Ergebnisse zeigen, dass eine biomechanische Ganganalyse den Kliniker in der Beurteilung von hypokinetischen Gangstörungen unterstützen kann und spezifische Gangmuster von IPS und NDH objektivierbar sind.

Abstract

Introduction:

The correct classification of hypokinetic gait disturbances by visual assessment frequently poses a difficult challenge for the busy neurologist. Computerised gait analysis (CGA) may help in the differential diagnosis of the underlying disorder. The aim of this study was to compare gait patterns by CGA in patients with idiopathic Parkinson’s disease (IPD) vs. those with normal pressure hydrocephalus (NPH).

Patients and Methods:

Comparative CGA of overground walking was carried out in patients with IPD (n=18), patients with NPH (n=18) and controls (C, n=18) matched for age, height and weight. Biomechanical devices included kinematic motion analysis SIMI^® (step height, step width, arm abduction and shoulder amplitude) and plantar pressure NOVEL^® Pedar (heel, midfoot, forefoot load and spatiotemporal parameters). The statistical procedure used was a one-way ANOVA with post hoc test Scheffé.

Results:

Specific features of the gait disturbance in IPD (Hoehn and Yahr stage<2.5, “on” state) were significantly reduced shoulder excursion and increased arm abduction on both sides. Spatiotemporal, foot loading and feet kinematics were only moderately reduced in comparison with C. Compared to patients with IPD and C, NPH patients showed a more broad-based gait with reduced stride length and increased number of steps, and significantly increased arm abduction on both sides.

Conclusion:

Our results suggest that biomechanical gait analysis may help clinicians to differentiate and classify visually similar hypokinetic gait disorders.

Schlüsselwörter

Ganganalyse - idiopathisches Parkinson-Syndrom - Normaldruckhydrozephalus

Keywords

gait analysis - Parkinson’s disease - normal pressure hydrocephalus

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