Biomechanische Ganganalyse von neurodegenerativen Parkinson-Syndromen

Zusammenfassung

Einführung: Der Einsatzbereich biomechanischer Messverfahren bei der Evaluierung von Gangstörungen in der Neurologie wird zusehends häufiger. Die Studienlage zu vergleichenden biomechanischen Ganganalysen hypokinetisch-rigider Gangstörungen im Rahmen eines Parkinson-Syndroms ist derzeit noch gering. Das Ziel dieser Studie ist, Unterschiede der Gangfunktion bei Patienten mit idiopathischen Parkinson-Syndrom (IPS) und Patienten mit einem atypischen Parkinson-Syndrom (APS) zu objektivieren.

Methode: Mithilfe kinematischer und kinetischer Bewegungsanalyseverfahren wurde die Gangmotorik von IPS Patienten (n=12); APS Patienten (n=12) und einer gesunden Kontrollgruppe (K, n=12) analysiert.

Ergebnisse: APS Patienten gingen signifikant langsamer, kleinschrittiger und mit verlängerten Bodenkontaktphasen als IPS Patienten und einer gesunden K Gruppe. Zwischen den neurodegenerativen Erkrankungsgruppen APS und IPS wurde in den Bewegungsamplituden der oberen Extremitäten keine signifikante Differenz quantifiziert. An den unteren Extremitäten überwiegt eine proximale Bewegungseinschränkung der APS gegenüber IPS. Eine geringere Auftrittskraft und Abstoßkraft während der Bodenkontaktphase ist bei den APS im Vergleich zu IPS und K objektivierbar.

Schlussfolgerung: Mithilfe biomechanischer Ganganalyseverfahren können innerhalb der hypokinetisch-rigiden Gangstörungen unterschiedliche Gangcharakteristika objektiviert werden. Der Einsatzbereich könnte im klinischen Alltag für differenzialdiagnostische und therapeutische Überlegungen hilfreich sein.

Abstract

Background: Biomechanical measurement of neurological gait disorders has been increasingly used in recent years. However, prospective comparative studies of hypokinetic gait disorders are still sparse. The aim of this study was an objective comparison of gait parameters in subjects with idiopathic Parkinson’s disease (IPD, n=12), atypical parkinsonian syndromes (APS, n=12), and controls (n=12).

Methods: We quantified kinetics and kinematics in upper and lower extremities, trunk, and head in sagittal as well as spatiotemporal gait parameters.

Results: We found a significantly reduced walking speed with shortened step length and prolonged ground contact phase in APS subjects compared to PD subjects and controls. In addition, APS patients had more hypokinetic rigidity in lower extremities than in upper extremities compared to IPD and controls. Furthermore, loading force under the heel and active force for gait propulsion in the forefoot were reduced in APS compared to IPD and controls.

Conclusion: Our results suggest that biomechanical gait analysis may help clinicians to objectively differentiate typical gait characteristics in clinically similar hypokinetic gait disorders.

Schlüsselwörter

Parkinson-Syndrom - Atypisches Parkinson-Syndrom - Gangstörungen - Ganganalyse

Key words

parkinson’s disease - atypical parkinsonian syndromes - gait disorders - gait analysis

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