Quantitative Bewegungsanalyse der Rumpfmotorik von Parkinsonpatienten mittels dreidimensionaler Kinematik und Oberflächenelektromyografie

Zusammenfassung

Hintergrund Im Krankheitsverlauf der Parkinsonerkrankung (PD) werden axiale Defizite als Ausdruck einer reduzierten Rumpfmotorik prominent. Obwohl die Rumpfmotorikstörung progressiv verläuft und die tägliche Aktivität der Patienten beeinträchtigt wird, ist die quantitative Beurteilung noch nicht standardisiert und üblich. Methode Wir verglichen die Rumpfmotorik im 3-dimensionalen Raum mit synchroner Oberflächenelektromyografie (oEMG) von 19 PD-Patienten vom akinetisch-rigiden Subtyp (Hoehn & Yahr: 2–3, UPDRS motor score: 25,5 ± 10,7 in „on” Phase) mit einer altersgemachten Kontrollgruppe. Ergebnisse Die Rumpfbeweglichkeit (Range of Motion) war in frontaler, sagittaler und transversaler Ebene in der PD-Gruppe signifikant reduziert (Mittelwerte für alle Bewegungsrichtungen p < 0,001) mit jeweils signifikant erhöhter Bewegungsvariabilität (p < 0,001) bei reduzierter muskulärer Aktivität (oEMG). Die kinematischen Daten korrelierten nicht mit der täglichen L-Dopa-Dosis in mg. Schlussfolgerung Die 3-dimensionale Rumpfkinematik und die analoge Oberflächenelektromyografie ermöglichen den Klinikern und Therapeuten eine quantitative und objektive Beurteilung der Rumpfmotorik bei PD-Patienten. Der fehlende Einfluss von L-Dopa auf die Rumpfkinematik zeigt die unabhängige Kontrolle des axialen Tonus gegenüber des Extremitätentonus.

Abstract

Background In Parkinson's disease (PD) an axial deficit is common and expressed as trunk rigidity. Objective quantification of trunk rigidity is not part of routine clinical care of PD patients, although the subjective rating of rigidity may substantially differ between examiners. Method We compared the trunk performance of 19 akinetic-rigid PD patients (Hoehn & Yahr scale: 2–3, UPDRS motor score: 25.5 ± 10.7 during best „on”) and matched healthy control subjects (C) with 3D kinematics and surface electromyography (sEMG). Results In PD we found significantly reduced trunk amplitudes in sagittal, frontal and transversal planes (p < 0.001) with also significantly higher movement variability in all directions (p < 0.001). PD patients had reduced muscle activity (sEMG amplitude) in the erector trunci muscle and abdominal external oblique muscles on both sides. None of the biomechanical data correlated with the daily levodopa medication. Conclusion The 3D trunk kinematic and sEMG may represent a useful and easy handling tool for clinicians and therapists to quantify and objectively evaluate trunk function in PD patients. The absence of a levodopa effect on axial trunk performance suggests that neural circuits distinct from those controlling tone in the extremities may control axial tone.

Parkinsonerkrankung - Rumpfmotorik - 3D-Kinematik - Oberflächenelektromyografie

Parkinson's disease - trunk movements - 3D kinematics - surface electromyography

Literatur

• 1 Steiger M J, Thompson P D, Marsden C D. Disordered axial movement in Parkinson's disease.  J Neurol Neurosurg Psychiatry. 1996;  61 645-648
• 2 Stack E, Jupp K, Ashburn A. Developing methods to evaluate how people with Parkinson's disease turn 180 degrees: an activity frequently associated with falls.  Disabil Rehabil. 2004;  26 478-484
• 3 Verheyden G, Willems A M, Ooms L. et al . Validity of the trunk impairment scale as a measure of trunk performance in people with Parkinson's disease.  Arch Phys Med Rehabil. 2007;  88 1304-1308
• 4 Nikfekr E, Kerr K, Attfield S. et al . Trunk movement in Parkinson's disease during rising from seated position.  Mov Disord. 2002;  17 274-282
• 5 Fahn S, Elton R L. Members of the UPDRS development committee, 1987. Unified Parkinson's disease Rating Scale. In: Fahn S, Marsden CD, Calne DB, Goldstein M, eds Recent Developments in Parkinson's Disease. Vol 2.  Florham Park NJ; Macmillan Health Care 1987: 153-163, 293–304
• 6 Teräväinen H, Tsumi J KC, Mak E. et al . Optimal indices for testing parkinsonian rigidity.  Can J Neurol Sci. 1989;  16 180-183
• 7 Bridgewater K J, Sharpe M H. Trunk muscle performance in early Parkinson's disease.  Phys Ther. 1998;  78 566-576
• 8 Huxham F, Baker R, Morris M E. et al . Head and trunk rotation during walking turns in Parkinson's disease.  Mov Disord. 2008;  23 1391-1397
• 9 Vaugoyeau M, Viallet F, Aurenty R. et al . Axial Rotation in Parkinson's disease.  J Neurol Neurosurg Psychiatry. 2006;  77 815-821
• 10 Wright W G, Gurfinkel V S, Nutt J. et al . Axial hypertonicity in Parkinson's disease: direct measurements of trunk and hip torque.  Exp Neurol. 2007;  208 38-46
• 11 Mak M KY, Wong E CY, Hui-Chan C W. et al . Quantitative measurement of trunk rigidity in parkinsonian patients.  J Neurol. 2007;  254 202-209
• 12 Hughes A J, Daniel S E, Kilford L. et al . Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases.  J Neurol Neurosurg Psychiatry. 1992;  55 181-184
• 13 Allen N E, Canning C G, Sherrington C. et al . Bradykinesia, muscle weakness and reduced muscle power in Parkinson's disease.  Mov Disord. 2009;  24 1344-1351
• 14 Berardelli A, Rothwell J C, Thompson P D. et al . Pathophysiology of bradykinesia in Parkinson's disease.  Brain. 2001;  124 2131-2146
• 15 Gabell A, Nayak U S. The effect of age on variability in gait.  J Gerontol. 1984;  39 662-666
• 16 Tatton W G, Lee R G. Evidence for abnormal long-loop reflexes in rigid Parkinsonian patients.  Brain Res. 1975;  100 671-676
• 17 Dietz V, Quintern J, Berger W. Electrophysiological studies of gait in spasticity and rigidity. Evidence that altered mechanical properties of muscle contributes to hypertonia.  Brain. 1981;  104 431-449
• 18 Marsden C D. The mysterious motor function of the basal ganglia: the Robert Wartenberg Lecture.  Neurology. 1982;  32 514-539
• 19 Hausdorff J M, Cudkowicz M E, Firtion R. et al . Gait variability and basal ganglia disorders: stride-to-stride variations of gait cycle timing in Parkinson's disease and Huntington's disease.  Mov Disord. 1998;  13 428-437
• 20 Nieuwboer A, Dom R, De Weerdt W. et al . Electromyographic profiles of gait prior to onset of freezing episodes in patients with Parkinson's disease.  Brain. 2004;  127 1650-1660
• 21 Pääsuke M, Ereline J, Gapeyeva H. et al . Leg-extension strength and chair-rise performance in elderly women with Parkinson's disease.  J Aging Phys Act. 2004;  12 511-524
• 22 Umapathi T, Chaudhry V, Cornblath D. et al . Head drop and camptocormia.  J Neurol Neurosurg Psychiatry. 2002;  73 1-7
• 23 Margraf N G, Wrede A, Rohr A. et al . Camptocormia in idiopathic Parkinson's disease: a focal myopathy of the paravertebral muscles.  Mov Disord. 2010;  5 542-551
• 24 Spuler S, Krug H, Klein C. et al . Myopathy causing camptocormia in idiopathic Parkinson's disease: a multidisciplinary approach.  Mov Disord. 2010;  25 552-559
• 25 Bloem B R, Grimbergen Y A, 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
• 26 Joya J E, Kee A J, Nair-Shalliker V. et al . Muscle weakness in a mouse model of nemaline myopathy can be reversed with exercise and reveals a novel myofiber repair mechanism.  Hum Mol Genet. 2004;  13 2633-2645
• 27 Bejjani B P, Gervais D, Arnulf I. et al . Axial parkinsonian symptoms can be improved: the role of levodopa and bilateral subthalamic stimulation.  J Neurol Neurosurg Psychiatry. 2000;  68 595-600
• 28 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
• 29 Meara R J, Cody F W. Relationship between electromyographic activity and clinically assessed rigidity studied at the wrist joint in Parkinson's disease.  Brain. 1992;  115 1167-1180