Lokomotorisches Assessment

Zusammenfassung

Einschränkungen der Fortbewegung sind die pathogenetische Endstrecke des Alterungsprozesses und vieler Erkrankungen. Die quantifizierende Messung von Bewegung gehört deshalb unverzichtbar zu einer medizinischen Untersuchung. Diese Art der Funktionsdiagnostik wird lokomotorisches Assessment genannt und spielt als Sturzrisikoassessment eine wichtige Rolle in der Geriatrie (vgl. EBM 2000plus, GOP 03341). Zur detaillierten Zusammensetzung eines solchen Assessments gibt es noch keinen allgemeinen Konsens. Der Artikel stellt häufig eingesetzte Messverfahren wie den up & go-Test, die frei gewählte Gehgeschwindigkeit, den Aufstehtest und die Tandemmanöver in Grundlagen, Durchführung und Aussagekraft vor. Die Physik der Bewegung als Schwingung wird dargestellt, und ebenso die Differenzierung zwischen Kraft und Leistung. Die objektive Messung der motorischen Leistung bei Vertikalbewegungen (power output) erweist sich als hoch korreliert mit dem Alter und deshalb besonders relevant zur Erfassung des motorischen Alterungsprozesses. Die Leistung einer körperlichen Aktivität ist auch die Basis für die Beurteilung der kardiovaskulären Reaktionen und Risiken und damit für die ärztliche Verordnung von Bewegung. Sie wird durch neue Technologien wie der Mechanographie mit dem Leonardo-System im praktischen medizinischen Alltag möglich. Die quantifizierende Funktionsdiagnostik der Lokomotion ist zudem ein zentraler Marker des „Frailty-Syndroms“, das als „Vorstufe der Pflegebedürftigkeit” ein neues Konzept für frührehabilitative medizinische Interventionen darstellt.

Summary

Locomotor disorders are the common pathogenetic pathway of the aging process and many age-related diseases. Quantifying measures of locomotion is therefore an indispensable part of a medical examination. The locomotor assessment is an effective tool for stratifying risk fall status and directing fall prevention. The article presents some commonly used locomotor performance tests: up & go-test, self selected gait velocity, chair rising test, tandem manoeuvres, and discusses interpreting and administering of the tests. The physics of human movement is introduced as being vital for understanding the diagnosis and treatment of locomotor disorders. Human movement is described as oscillation, i.e. a continuous exchange between kinetic and potential energy which is realized within the locomotor system as a pendulum-like and spring-like storage and exchange of energy. Related to the physics of movement, the differentiation between force and power is important: power is the parameter which is most strongly correlated to the aging process, to cardiovascular adaptations and risks and to the subjective perception of exertion. Power measurement is indispensable for the prescription of exercise and assessing its risks. New technologies like the Leonardo mechanography enable the measurement of power on a force plate during normal, unrestricted movements. Loco-motor performances have been proven to be core markers of frailty. The frailty syndrome is attracting increasing attention in the field of geriatrics as the ideal period for preventive interventions against age-related disability.

Schlüsselwörter

Lokomotorisches Assessment - Leistung - Mechanographie - Frailty-Syndrom

Keywords

Locomotor assessment - power - performance tests - mechanography - frailty

• Literatur

• 1 Runge M.. Gehstörungen, Stürze, Hüftfrakturen. Darmstadt: Steinkopff; 1998
• 2 Rubenstein LZ., Wieland D.. Comprehensive geriatric assessment. Ann Rev Gerontol Geriatr 1989; 9: 145-92.
• 3 Rittweger J., Schiessl H., Felsenberg D., Runge M.. Reproducibility of the Jumping Mechanography As a Test of Mechanical Power Output in Physically Competent Adult and Elderly Subjects. J Am Geriatr Soc 2004; 52: 128-31.
• 4 Runge M., Rittweger J., Russo CR., Schiessl H., Felsenberg D.. Is muscle power output a key factor in the age-related decline in physical performance? A comparison of muscle cross section, chair-rising test and jumping power. Clin Physiol Funct Imaging 2004; 24: 335-40.
• 5 Cuoco A., Callahan DM., Sayers S.. et al. Impact of muscle power and force on gait speed in disabled older men and women. J Gerontol A Biol Sci Med Sci 2004; Nov 59 (11) 1200-6.
• 6 Bean JF., Leveille SG., Kiely DK.. et al. A comparison of leg power and leg strength within the In-CHIANTI study: which influences mobility more?. J Gerontol A Biol Sci Med Sci 2003; Aug 58 (08) 728-33.
• 7 Podsiadlo D., Richardson S.. The Timed „Up & Go“: A Test of basic functional mobility for frail elderly persons. Am Geriatr Soc 1991; 39: 142-8.
• 8 Guralnik JM., Ferrucci L., Simonsick EM.. et al. Lower-Extremity Function in Persons Over the Age of 70Years as a Predictor of Subsequent Disability. N Engl J Med 1995; 332: 556-61.
• 9 Guralnik JM., Ferrucci L., Pieper CF.. et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci 2000; Apr 55 (04) M221-31.
• 10 Newman AB., Simonsick EM., Naydeck BL.. et al. Association of long-distance corridor walk performance with mortality, cardiovascular disease, mobility limitation, and disability. JAMA 2006; May 3 295 (17) 2018-26.
• 11 Cahalin LP., Mathier MA., Semigran MJ.. et al. The six-minute walk test predicts peak oxygen uptake and survival in patients with advanced heart failure. Chest 1996; 110 (02) 325-32.
• 12 Lederer DJ., Arcasoy SM., Wilt JS.. et al. Six-Minute Walk Distance Predicts Waiting List Survival in Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2006; Jun; 15 (Epub ahead of print).
• 13 Runge M.. Die multifaktorielle Pathogenese von Gehstörungen, Stürzen und Hüftfrakturen im Alter. Z Gerontol Geriatr 1997; 30 (04) 267-75.
• 14 Tinetti ME., Williams TF., Mayewski R.. Fall risk index for elderly patients based on number of chronic disabilities. Am J Med 1986; 80: 429-34.
• 15 Robbins AS., Rubenstein LZ., Josephson KR.. et al. Predictors of falls among elderly people. Results of two population-based studies. Arch Intern Med 1989; 149: 1628-33.
• 16 Chang JT., Morton SC., Rubenstein LZ.. et al. Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials. BMJ 2004; Mar 20 328 7441 680.
• 17 Gillespie LD., Gillespie WJ., Robertson MC.. et al. Interventions for preventing falls in elderly people. Cochrane Database Syst Rev 2003; (04) CD000340.
• 18 Tinetti ME., Baker I D., McAvay G.. et al. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994; 331: 821-7.
• 19 Fried LP., Tangen CM., Walston J.. et al. Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci 2001; 56 (03) M146-56.
• 20 Ferrucci L., Guralnik JM., Studenski S.. et al. The Interventions on Frailty Working Group. Designing randomized, controlled trials aimed at preventing or delaying functional decline and disability in frail, older persons: A consensus report. J Am Geriatr Soc 2004; 52: 625-34.
• 21 Fried LP., Ferrucci L., Darer J.. et al. Untangling the concepts of disability, frailty, and comorbidity: Implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004; 59 (03) 255-263.
• 22 Gill TM., Baker DI., Gottschalk M.. et al. A Program to Prevent Functional Decline in Physically Frail, Elderly Persons Who Live at Home. NEJM 2002; 347: 1068-74.
• 23 Cummings SR., Nevitt MC., Browner WS.. et al. for the Study of Osteoporotic Fractures Research Group. Risk factors for hip fracture in white women. N Engl J Med 1995; 332: 767-73.
• 24 Lindsay R., James EL., Kippen S.. The Timed Up and Go Test: unable to predict falls on the acute medical ward. Aust J Physiother 2004; 50 (04) 249-51.
• 25 Dibble LE., Lange M.. Predicting falls in individuals with Parkinson disease: a reconsideration of clinical balance measures. J Neurol Phys Ther 2006; 30 (02) 60-7.
• 26 Large J., Gan N., Basic D., Jennings N.. Using the timed up and go test to stratify elderly inpatients at risk of falls. Clin Rehabil 2006; 20 (05) 421-8.
• 27 Studenski S., Perera S., Wallace D.. et al. Physical performance measures in the clinical setting. J Am Geriatr Soc 2003; 51 (03) 314-22.