Posturale Instabilität bei Morbus Parkinson

S. Turbanski

doi:10.1055/s-0028-1109540

manuelletherapie 2009; 13(3): 117-123
DOI: 10.1055/s-0028-1109540

aus der Praxis – für die Praxis

Posturale Instabilität bei Morbus Parkinson

Ursachen, Erscheinungsformen, Evaluation und TherapieansätzePostural Instability in Parkinsons’s DiseaseCauses, Manifestations, Evaluation and Therapy ApproachesS. Turbanski¹

¹Institut für Sportwissenschaften, Johann Wolfgang Goethe Universität Frankfurt am Main

Abstract

Zusammenfassung

Die posturale Instabilität stellt ein klinisches Kardinalsymptom bei Morbus Parkinson dar, das die Mobilität der Patienten beeinträchtigt und ihr Sturzrisiko erhöht. Da die klinische Erfassung in der Kritik steht und die Defizite der posturalen Kontrolle medikamentös nicht behandelt werden können, gewinnt diese Problematik in der motorischen Bewegungsforschung sowie in der Physio- und Sporttherapie an Bedeutung.

Für eine adäquate Messung und eine optimierte Therapie der posturalen Instabilität sind Kenntnisse über die Ursachen, Erscheinungsformen, Evaluation und bisherige Therapieansätze notwendig. Diese Punkte werden im vorliegenden Übersichtsartikel dargestellt und diskutiert.

Abstract

Postural instability is a clinical cardinal symptom in Parkinsons’s disease which affects the patients’ mobility and increases their risk of falls. As clinical measurement of postural instability is under criticism and postural control deficits cannot be treated by medication this problem has gaines more importance in movement research as well as in physiotherapy and sports therapy.

Appropriate measurement and optimised therapy of postural instability necessitate knowledge about causes, manifestations, evaluation and previous therapy approaches. This review portrays and discusses these issues.

Schlüsselwörter

Morbus Parkinson - posturale Instabilität - Propriozeption

Key words

Parkinsons’s disease - postural instabilty - proprioception

Volltext

Referenzen

Literatur

1 Adkin A L, Frank J S, Jog M S. Fear of falling and postural control in Parkinson’s disease. Mov Disord. 2003; 18 496-502
2 Allum J H, Carpenter M G, Honegger F. et al . Age-dependent variations in the directional sensitivity of balance corrections and compensatory arm movements in man. J Physiol. 2002; 542 643-663
3 Ashburn A, Stack E, Pickering R M. et al . A community-dwelling sample of people with Parkinson’s disease: characteristics of fallers and non-fallers. Age and Aging. 2001; 30 47-52
4 Bennett D A, Beckett L A, Murray A M. et al . Prevalence of Parkinsonian Signs and Associated Mortality in a Community Population of Older People. N Engl J Med. 1996; 334 71-76
5 Berg K O, Wood-Dauphinee S L, Williams J L. et al . Measuring balance in the elderly: validation of an instrument. Can J Public Health. 1992; 83 (Suppl 2) S7-S11
6 Bloem B R, Beckley D J, Van Dijk J G. et al . Influence of dopaminergic medication on automatic postural responses and balance impairment in Parkinson’s disease. Mov Disord. 1996; 11 509-521
7 Bloem B R, Beckley D J, Van Hilten B J. et al . Clinimetrics of postural instability in Parkinson’s disease. J Neurol. 1998; 245 669-673
8 Bloem B R, Beckley D J, Dijk J G. Are automatic postural responses in patients with Parkinson’s disease normal to their stooped posture?. Exp Brain Res. 1999; 124 481-488
9 Bloem B R, Grimbergen Y AM, Cramer van M. et al . Prospective assessment of falls in Parkinson’s disease. J Neurol. 2001; 248 950-958
10 Bloem B r, Valkenburg V V, Slabbekoorn M. et al . The Multiple Task Test – Development and normal strategies. Gait and Posture. 2001; 14 191-202
11 Bloem B R, Grimbergen Y AM, Van Dijk J G. et al . The ”posture second” strategy: A review of wrong priorities in Parkinson’s disease. J Neurol Sci. 2006; 248 196-204
12 Bronstein A M, Hood J D, Gresty M A. et al . Visual control of balance in cerebellar and parkinsonian syndromes. Brain. 1990; 113 767-779
13 Bronte-Stewart H M, Minn A Y, Rodrigues K. et al . Postural instability in idiopathic Parkinson’s disease: the role of medication and unilateral pallidotomy. Brain. 2002; 9 2100-2112
14 Brown P, Chen C C, Wang S. et al . Involvement of human basal ganglia in offline feedback control of voluntary movement. Curr Biol. 2006; 16 2129-2134
15 Carpenter M G, Allum J HJ, Honegger F. Directional sensitivity of stretch reflexes and balance corrections for normal subjects in the roll and pitch planes. Exp Brain Res. 1999; 129 93-113
16 Carpenter M G, Allum J HJ, Honegger F. et al . Postural abnormalities to multidirectional stance perturbations in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2004; 75 1245-1254
17 Chong R KY, Jones C L, Horak F B. Parkinson’s disease impairs the ability to change set quickly. J Neurol Sci. 2000; 175 57-70
18 Cody F W, MacDermott N, Matthews P B. et al . Observations on the genesis of stretch reflexes in Parkinson’s disease. Brain. 1986; 109 229-249
19 Collins J J, De Luca C J. The effects of visual input on open-loop and closed-loop postural control mechnanisms. Exp Brain Res. 1995; 103 151-163
20 Comella C L, Stebbins G T, Brown-Toms N. et al . Physical therapy and Parkinson’s disease: a controlled clinical trial. Neurology. 1994; 44 376-378
21 Demirci M, Grill S, McShane L. et al . A mismatch between kinesthetic and visual perception in Parkinson’s disease. Ann Neurol. 1997; 41 781-788
22 Dietz V, Berger W, Hostmann G A. Posture in Parkinson’s disease: impairment of reflexes and programming. Ann Neurol. 1988; 24 660-669
23 Dietz V, Zijlstra W, Assaiante C. et al . Balance control in Parkinson’s disease. Gait and Posture. 1993; 1 77-84
24 Dimitrova D, Horak F B, Nutt J G. Postural Muscle Response to Multidirectional Translations in Patients With Parkinson’s Diesase. J Neurophysiol. 2004; 91 489-501
25 Ebersbach G, Müller J, Soer M. et al . Quantitative measurement of postural instability in Parkinson’s disease. Mov Disord. 2000; 15 (Suppl 3) 74
26 Ellis T, Goede C J, Feldman R G. et al . Efficacy of a physical therapy program in patients with Parkinson’s disease: a randomized controlled trial. Arch Phys Med Rehabil. 2005; 86 626-632
27 Van Emmerik R E, Wagenaar R C, Winogrodzka de A. et al . Identification of axial rigidity during locomotion in Parkinson’s disease. Arch Phys Med Rehabil. 1999; 80 186-191
28 Frank J S, Horak F B, Nutt J. Centrally Initiated Postural Adjustments in Parkinsonian Patients On and Off Levodopa. J Neurophysiol. 2000; 84 2440-2448
29 Gardner M M, Robertson M C, Campbell A J. Exercise in preventing falls and fall-related injuries in older people: a review of randomised controlled trials. Br J Sports Med. 2000; 34 7-17
30 Gerlach M, Reichmann H, Riederer P. Die Parkinson-Krankheit. Grundlagen – Klinik – Therapie. Wien; Springer 2003
31 Gray P, Hildebrand K. Fall risk factors in Parkinson’s disease. J Neurosci Nurs. 2000; 32 222-228
32 Grimbergen Y, Munneke M, Bloem B R. Falls in Parkinson’s disease. Current Opinion in Neurology. 2004; 17 405-415
33 Guttman M, Kish S J, Furukawa Y. Current concepts in the diagnosis and management of Parkinson’s disease. CMAJ. 2003; 168 293-301
34 Gwinn-Hardy K. Genetics of Parkinsonism. Mov Disord. 2002; 17 645-656
35 Hirsch M A, Toole T, Maitland C G. et al . The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson’s disease. Arch Phys Med Rehabil. 2003; 84 1109-1117
36 Horak F B, Nutt J G, Nashner L M. Postural inflexibility in parkinsonian subjects. J Neurol Sci. 1992; 111 46-58
37 Horak F B, Frank J, Nutt J. Effects of dopamine on postural control in parkinsonian subjects: scaling, set and tone. J Neurophysiol. 1996; 75 2380-2396
38 Horak F B, Dimitrova D, Nutt J G. Direction-specific postural instability in subjects with Parkinson’s disease. Exp Neurol. 2005; 193 504-521
39 Jacobs J V, Horak F B. Abnormal proprioceptive-motor integration contributes to hypometric postural responses of subjects with Parkinson’s disease. Neuroscience. 2006; 141 999-1009
40 Jacobs J V, Horak F B, Tran V K. et al . An alternative clinical postural stability test for patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2006; 77 322-326
41 Jankovic J, McDermott M, Carter J. et al . Variable expression of Parkinson’s disease: a base-line analysis of the DATATOP cohort. The Parkinson Study Group. Neurology. 1990; 40 1529-1534
42 Jankovic J, Rajout A H, McDermott M P. et al . The Evolution of Diagnosis in Early Parkinson’s Disease. Arch Neurol. 2000; 57 369-372
43 Jankovic J. Levodopa – strengths and weaknesses. Neurology. 2002; 58 (Suppl 1) 19-32
44 Jöbges M, Heuschkel G, Pretzel C. et al . Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 2004; 75 1682-1687
45 Jobst E E, Melnick M E, Byl N N. et al . Sensory perception in Parkinson’s disease. Arch Neurol. 1997; 54 450-454
46 Khudados E, Cody F WJ, O’Boyle D J. Proprioceptive regulation of voluntary ankle movements, demonstrated using muscle vibration is impaired by Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1999; 67 504-510
47 Klawans H L. Individual manifestations of Parkinson’s disease after ten or more years of levodopa. Mov Disord. 1986; 1 187-192
48 Klockgether T, Borutta M, Rapp H. et al . A defect of kinesthesia in Parkinson’s disease. Mov Disord. 1995; 10 460-465
49 Koller W, Olanow C, Shoulson I. Variable expression of Parkinson’s disease. A baseline expression of the DATA-TOP study cohort. Neurol. 1990; 40 1529-1534
50 Lang A E, Lozano A M. Parkinson’s disease. N Engl J Med. 1998; 339 1044-1053, 1130 – 1143
51 Lord S R, Clark R D, Webster I W. Postural stability and associated physiological factors in a population of aged persons. J Gerontol. 1991; 46 69-76
52 Lord S R, Rogers M W, Howland A. et al . Lateral stability, sensorimotor function and falls in older people. J Am Geriatric Soc. 1999; 47 1077-1081
53 Marchese R, Bove M, Abbruzzese G. Effect of Cognitive and Motor Tasks on Postural Stability in Parkinson’s disease: A Posturographic Study. Mov Disorder. 2003; 18 652-658
54 Marsden C D, Obeso J A. The functions of the basal ganglia and the paradox of stereotaxic surgery in Parkinson’s disease. Brain. 1994; 117 877-897
55 Mitchell S L, Collins J J, De Luca C J. et al . Open-loop and closed-loop postural control mechanisms in Parkinson’s disease: increased mediolateral activity during quiet standing. Neurosci Lett. 1995; 197 133-136
56 Moore A P. Impaired sensorimotor integration in parkinsonism and dyskinesia: a role of corollary discharges. J Neurol Neurosurg Psychiatry. 1987; 50 544-552
57 Morris S, Morris M E, Iansek R. Performance on clinical tests of balance in Parkinson’s disease. Phys Ther. 1998; 81 810-818
58 Morris M E. Movement Disorders in People with Parkinson’s Disease: A Model for Physical Therapy. Physical Therapy. 2000; 80 578-597
59 Morris M E, Iansek R, Smithson F. et al . Postural instability in Parkinson’s disease: a comparison with and without a concurrent task. Gait and Posture. 2000; 12 205-216
60 Nardone A, Siliotto R, Grasso M. et al . Influence of aging on leg muscle reflex response to stance perturbations. Archives of Physical Medicine and Rehabilitation. 1995; 76 158-165
61 Newstead A H, Hinman M R, Tomberlini J A. Reliability of the Berg Balance Scale and Master Limits of Stability Test for individuals with Brain Injury. Journal of Neurologic Physical Therapy. 2005; 29 18-23
62 O’Suilleabhain P, Bullard J, Dewey R B. Proprioception in Parkinson’s disease is actually depressed by dopaminergic medications. J Neurol Neurosurg Psychiatry. 2001; 71 607-610
63 Parkinson J. An essay on the shaking palsy. London; Sherwood, Neely & Jones 1817
64 Pellecchia M T, Grasso A, Biancardi L G. et al . Physical therapy in Parkinson’s disease: an open long-term rehabilitation trial. J Neurol. 2004; 251 595-598
65 Perrin P P, Gauchard G C, Perrot C. et al . Effects of physical and sporting activities on balance control in elderly people. Br J Sports Med. 1999; 33 121-126
66 Peterka R J, Loughlin P J. Dynamic regulation of sensorimotor integration in human postural control. J Neurophysiol. 2004; 91 410-423
67 Reuter I, Engelhardt M, Stecker K. et al . Therapeutic value of exercise training in Parkinson’s disease. Med Sci Sports Exerc. 1999; 11 1544-1549
68 Rickards C, Cody F WJ. Proprioceptive control of wrist movements in Parkinson’s disease. Brain. 1997; 120 977-990
69 Robert-Warrior D, Overby A, Jankovic J. et al . Postural control in Parkinson’s disease after unilateral posteroventral pallidotomy. Brain. 2000; 123 2141-2149
70 Rocchi L, Chiari L, Cappello A. et al . Identification of distinct characteristics of postural sway in Parkinson’s disease: a feature selection procedure based on principal component analysis. Neurosci Lett. 2006; 394 140-145
71 Schieppati M, Hugon M, Grasso M. et al . The limits of equilibrium in young and elderly normal subjects and in parkinsonians. Electroencephalogr Clin Neurophysiol. 1994; 93 286-298
72 Schrag A, Jahanshahi M, Quinn N. What contributes to quality of life in patients with Parkinson’s disease?. J Neurol Neurosurg Psychiatry. 2000; 69 308-312
73 Smithson F, Morris M E, Jansek R. Performance on clinical tests of balance in Parkinson’s disease. Phy Ther. 1998; 8 577-592
74 Stankovic I. The effects of physical therapy on balance of patients with Parkinson’s disease. International Journal of Rehabilitation Research. 2004; 27 53-57
75 Tanner C M, Ottman R, Goldman S M. et al . Parkinson’s disease in twins: an etiologic study. JAMA. 1999; 281 341-346
76 Tinetti M E. Performance-oriented assessment of mobility problems in elderly patients. J Am Geriatr Soc. 1986; 34 119-126
77 Tinetti M E. Preventing Falls in Elderly People. N Engl J Med. 2003; 348 42-49
78 Tinetti M E, Gordon C, Sogolow E. et al . Fall-risk evaluation and management: challenges in adopting geriatric care practices. Gerontologist. 2006; 46 717-725
79 Trenkwalder C, Paulus W, Krafczyk S. et al . Postural stability differentiates „lower body” from idiopathic parkinsonism. Acta Neurol Scand. 1995; 91 444-452
80 Turbanski S, Haas C T, Schmidtbleicher D. Effects of random whole-body vibration on postural stability in Parkinson’s disease. Research in Sports Medicine: An International Journal. 2005; 3 243-256
81 Turbanski S. Zur posturalen Kontrolle bei Morbus Parkinson – Biomechanische Diagnose und Training [Dissertation]. Frankfurt/M; Universität Frankfurt 2006
82 Turbanski S, Haas C T, Schmidtbleicher D. Comparison of biomechanical and clinical assessment of postural stability in Parkinson’s disease. Clinical Neurophysiology. 2006; 4 E104-E105
83 Turbanski S, Haas C T, Schmidtbleicher D. Short-term effects of sensorimotor training on postural reflexes in parkinsonian subjects. Abstractbook. 11th Annual Congress ECSS Congress Lausanne; 2006: 264-265
84 Visser M, Marinus J, Bloem B R. et al . Clinical tests for the evaluation of postural instability in patients with Parkinson’s disease. Arch Phys Med Rehabil. 2003; 84 1669-1674
85 Waterston J A, Hawken M B, Tanyeri S. et al . Influence of sensory manipulation on postural control in Parkinson’s disease. J Neurol Neurosurg Psychiatry. 1993; 56 1276-1281
86 Wood B H, Bilclough J A, Bowron A. et al . Incidence and prediction of falls in Parkinson’s disease: a prospective and multidisciplinary study. J Neurol Neurosurg Psychiatry. 2002; 72 721-725
87 Zia S, Cody F, O’Boyle D. Joint position sense is impaired by Parkinson’s disease. Ann Neurol. 2000; 47 218-228

Dr. Stephan Turbanski

Institut für Sportwissenschaften, Johann Wolfgang Goethe Universität Frankfurt am Main

Ginnheimer Landstr. 39

60487 Frankfurt

eMail: turbanski@sport.uni-frankfurt.de