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Nervenheilkunde 2018; 37(04): 249-256
DOI: 10.1055/s-0038-1641682
Morbus Parkinson
Schattauer GmbH

Stürze bei Patienten mit leichtem und fortgeschrittenem Parkinson-Syndrom und ihre Prophylaxe durch Physiotherapie

Falls in patients with Parkinson’s disease syndromes and their prevention with physiotherapy
K. Ziegler
1   Abteilung Neurologie und klinische Neurophysiologie, Zentrum für Parkinson-Syndrome und Bewegungsstörungen, Schön Klinik, München-Schwabing
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Publikationsverlauf

eingegangen am: 01. Dezember 2017

angenommen am: 19. Dezember 2017

Publikationsdatum:
02. April 2018 (online)

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Zusammenfassung

Stürze sind markante klinische Meilensteine der Parkinsonerkrankung. Sie treten hauptsächlich in fortgeschrittenen Phasen der Erkrankung auf, doch auch zu Beginn gibt es ein Sturzrisiko, das häufig unterschätzt ist. Verglichen zur gesunden, altersentsprechenden Bevölkerung ist das Sturzrisiko mindestens verdreifacht, und mit einer großen Gefahr von Frakturen, insbesondere des Femurhalses, verknüpft. Hohe Kosten, Krankenhauseinweisungen, Beeinträchtigungen der Lebensqualität von Patienten und Angehörigen sind die Folge. Prädiziert werden Stürze vor allem durch vorangegangene Ereignisse, Schwierigkeiten beim gleichzeitigen Ausführen von Zusatzaufgaben während des Gehens, Zuteilung zum Typ des postural-instability- gait-disorder (PIGD), Freezing und Gleichgewichtsdefiziten. Ein standardisiertes Assessment hilft, die Ursachen zu identifizieren und maßgeschneiderte Interventionen auszuwählen. Sturzprävention bedarf Elementen zum Kraft- und Gleichgewichtstraining, zur Vermeidung und Überwindung von Freezing, Wohnraumanpassung und Hilfsmittelversorgung. Sturzprophylaxe sollte in den frühen Stadien beginnen, da dann die Effektivität größer ist. Allgemeine Tipps zur Vorbeugung vor Bewegungsmangel, Gehtraining mit kognitiven Zusatzaufgaben sowie komplexe, die Balanceleistungen forcierende Bewegungsformen wie Tai Chi und Tanz sind geeignete Angebote.

Summary

Falls are prominent clinical milestones in Parkinson’s disease (PD). They occur mainly during the later stages of the disease. In the early stages the risk to fall often is underestimated. Compared to healthy controls there is a threefold fall risk. It is related to fractures, especially of the femoral neck. Thus, falls lead to high costs, hospitalization and impaired quality of life of patients and their relatives. Predictors for falls are previous falls, difficulties with dual-tasking during walking, phenomenological postural-instability-gait-disorder (PIGD) type, freezing and postural instability. Standardised assessments are important to identify fall risk and to develop tailored interventions. Fall prevention programs include resistance and balance training, strategies to prevent or overcome freezing, allocation of assisting devices and practical advice for the modification of the home environment. Fall prevention should start early. Advice to prevent a sedentary lifestyle, walking with cognitive-dual-tasking and complex movement training such as Tai Chi Chuan or Dance, which focus on balance are suitable interventions.

Schlüsselwörter

Sturzprophylaxe - Tai Chi - Gleichgewichtstraining - Krafttraining - Freezing

Keywords

Fall prevention - Tai Chi Chuan - balance training - resistance training - freezing
 

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