Gangstörungen

Zusammenfassung

Der aufrechte Gang des Menschen bedingt eine komplexe Steuerung durch das Nervensystem. Störungen des Ganges sind daher vielfältig und häufig. Die Gangstörung weist oft den Weg zur Diagnose. Sie ist zudem häufig das Frühsymptom einer sich entwickelnden zugrunde liegenden Störung. Stürze sind meist Folgen von Gangstörungen und vielfach mit Fraktur und Trauma vergesellschaftet. Das Erkennen und die Einordnung der Gangstörung zur korrekten Diagnose ermöglicht in vielen Fällen eine rationale Therapie, die Komplikationen verhindert und die Lebensqualität und Mobilität der Patienten erhöht.

Summary

The upright human gait requiresa complex acting nervous system. Therefore, gait disorders are various and frequent. The gait disorder often leads the way to the correct diagnosis. Frequently, it is an early sign ofa developing underlying disease. Falls mostly occur as the consequence of gait disorders and are associated with fracture and trauma. The identification and classification of the gait disorder to the correct diagnosis leads to a rationale therapy, reduces complications and increases the quality of life and the mobility of the patient.

Schlüsselwörter

Gangstörung - Stürze - Lokomotion - Parkinson

Keywords

Gait disorder - falls - locomotion - parkinsonism

• Literatur

• 1 Bloem BR, Haan J, Lagaay AM, van Beek W, Wintzen AR, Roos RA. Investigation of gait in elderly subjects over 88 years of age. Journal of geriatric psychiatry and neurology 1992; Apr-Jun; 05 (02) 78-84.
• 2 Sudarsky L. Gait disorders: prevalence, morbidity, and etiology. Adv Neurol 2001; 87: 111-117.
• 3 Bloem BR, Gussekloo J, Lagaay AM, Remarque EJ, Haan J, Westendorp RG. Idiopathic senile gait disorders are signs of subclinical disease. J Am Geriatr Soc 2000; Sep; 48 (09) 1098-1101.
• 4 Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H. Abnormality of gait as a predictor of non-Alzheimer’s dementia. N Engl J Med 2002; Nov 28; 347 (22) 1761-1768.
• 5 Scarmeas N, Albert M, Brandt J, Blacker D, Hadjigeorgiou G, Papadimitriou A. et al. Motor signs predict poor outcomes in Alzheimer disease. Neurology 2005; May 24; 64 (10) 1696-1703.
• 6 Wilson RS, Schneider JA, Beckett LA, Evans DA, Bennett DA. Progression of gait disorder and rigidity and risk of death in older persons. Neurology 2002; Jun 25; 58 (12) 1815-1819.
• 7 Alexander NB. Gait disorders in older adults. J Am Geriatr Soc 1996; Apr; 44 (04) 434-451.
• 8 Baezner H, Hennerici M. From trepidant abasia to motor network failure--gait disorders as a consequence of subcortical vascular encephalopathy (SVE): review of historical and contemporary concepts. J Neurol Sci 2005; Mar 15; 229-230: 81-88.
• 9 Nutt JG, Marsden CD, Thompson PD. Human walking and higher-level gait disorders, particularly in the elderly. Neurology 1993; Feb; 43 (02) 268-279.
• 10 Schröteler F. Evidenzbasierte Physiotherapie beim Parkinson-Syndrom. Nervenheilkunde 2005; 24: 879-83.
• 11 Vieregge P, Conrad B. Gangstörungen. In: Ceballos-Baumann A, Conrad B. (eds.) Bewegungsstörungen. 2 ed. Stuttgart: Thieme; 2005: 308-318.
• 12 Ceballos-Baumann A, Ebersbach G. Beübende Verfahren in der Therapie von Parkinsonsyndromen (im Druck). Stuttgart: Thieme; 2007
• 13 Schröteler F. Evidenzbasierte Physiotherapie bei Morbus Parkinson – Einsatz äußerer Schrittmacher bei der Behandlung der Akinese. Psychoneuro 2006; 32: 431-435.
• 14 Dietz V. Spinal cord pattern generators for locomotion. Clin Neurophysiol 2003; Aug; 114 (08) 1379-1389.
• 15 Pahapill PA, Lozano AM. The pedunculopontine nucleus and Parkinson’s disease. Brain 2000; Sep; 123 (Pt 9): 1767-1783.
• 16 Woollacott M, Shumway-Cook A. Attention and the control of posture and gait: a review of an emerging area of research. Gait Posture 2002; Aug; 16 (01) 1-14.
• 17 Lundin-Olsson L, Nyberg L, Gustafson Y. „Stops walking when talking” as a predictor of falls in elderly people. Lancet 1997; Mar 1; 349 9052 617.
• 18 Snijders AH, van de Warrenburg BP, Giladi N, Bloem BR. Neurological gait disorders in elderly people: clinical approach and classification. Lancet Neurol 2007; 06 (01) 63-74.
• 19 Springer S, Giladi N, Peretz C, Yogev G, Simon ES, Hausdorff JM. Dual-tasking effects on gait variability: the role of aging, falls, and executive function. Mov Disord 2006; Jul; 21 (07) 950-957.
• 20 Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs. J Am Geriatr Soc 1999; Jan; 47 (01) 30-9.
• 21 Giladi N, Herman T, Reider II G, Gurevich T, Hausdorff JM. Clinical characteristics of elderly patients with a cautious gait of unknown origin. J Neurol 2005; Mar; 252 (03) 300-306.
• 22 Fahn S. The freezing phenomenon in parkinsonism. Adv Neurol 1995; 67: 53-63.
• 23 Hashimoto T. Speculation on the responsible sites and pathophysiology of freezing of gait. Parkinsonism Relat Disord 2006; 12: S55-S62.
• 24 Goetz CG, Leurgans S, Lang AE, Litvan I. Progression of gait, speech and swallowing deficits in progressive supranuclear palsy. Neurology 2003; Mar 25; 60 (06) 917-922.
• 25 Giladi N, Kao R, Fahn S. Freezing phenomenon in patients with parkinsonian syndromes. Mov Disord 1997; May; 12 (03) 302-5.
• 26 Benson RR, Guttmann CR, Wei X, Warfield SK, Hall C, Schmidt JA. et al. Older people with impaired mobility have specific loci of periventricular abnormality on MRI. Neurology 2002; Jan 8; 58 (01) 48-55.
• 27 Whitman GT, Tang Y, Lin A, Baloh RW. A prospective study of cerebral white matter abnormalities in older people with gait dysfunction. Neurology 2001; Sep 25; 57 (06) 990-904.
• 28 Demirkiran M, Bozdemir H, Sarica Y. Vascular parkinsonism:a distinct, heterogeneous clinical entity. Acta Neurol Scand 2001; Aug; 104 (02) 63-67.
• 29 Thompson PD, Marsden CD. Gait disorder of subcortical arteriosclerotic encephalopathy: Binswanger’s disease. Mov Disord 1987; 02 (01) 1-8.
• 30 Tullberg M, Hultin L, Ekholm S, Mansson JE, Fredman P, Wikkelso C. White matter changes in normal pressure hydrocephalus and Binswanger disease: specificity, predictive value and correlations to axonal degeneration and demyelination. Acta Neurol Scand 2002; Jun; 105 (06) 417-426.
• 31 Stolze H, Kuhtz-Buschbeck JP, Drucke H, Johnk K, Illert M, Deuschl G. Comparative analysis of the gait disorder of normal pressure hydrocephalus and Parkinson’s disease. J Neurol Neurosurg Psychiatry 2001; Mar; 70 (03) 289-297.
• 32 Luecking CH, Hellwig B. Uncommon tremors. In: Hallett M. ed. Handbook of Clinical Neurophysiology . New York: Elsevier BV; 2003: 397-415.
• 33 Glass GA, Ahlskog JE, Matsumoto JY. Orthostatic myoclonus: a contributor to gait decline in selected elderly. Neurology 2007; May 22; 68 (21) 1826-1830.
• 34 Factor SA, Podskalny GD, Molho ES. Psychogenic movement disorders: frequency, clinical profile, and characteristics. J Neurol Neurosurg Psychiatry 1995; Oct; 59 (04) 406-412.
• 35 Bhatia KP. Psychogenic gait disorders. Adv Neurol 2001; 87: 251-254.
• 36 Hayes MW, Graham S, Heldorf P, de Moore G, Morris JG. A video review of the diagnosis of psychogenic gait: appendix and commentary. Mov Disord 1999; Nov; 14 (06) 914-921.
• 37 Hinson VK, Haren WB. Psychogenic movement disorders. Lancet Neurol 2006; Aug; 05 (08) 695-700.
• 38 Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: II. Cardiac and analgesic drugs. J Am Geriatr Soc 1999; Jan; 47 (01) 40-50.
• 39 Ziere G, Dieleman JP, Hofman A, Pols HA, van der Cammen TJ, Stricker BH. Polypharmacy and falls in the middle age and elderly population. British journal of clinical pharmacology 2006; Feb; 61 (02) 218-223.
• 40 Zermansky AG, Alldred DP, Petty DR, Raynor DK, Freemantle N, Eastaugh J. et al. Clinical medication review bya pharmacist of elderly people living in care homes – randomised controlled trial. Age Ageing 2006; Nov; 35 (06) 586-591.