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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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Publication History

eingegangen am: 01 December 2017

angenommen am: 19 December 2017

Publication Date:
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
 

  • Literatur

  • 1 Kempster PA, O’Sullivan S, Holton JL, Revesz T, Lees AJ. Relationships between age and late progression of Parkinson’s disease: a clinico-pathological study. Brain Juni 2010; 133 (Pt 6): 1755-62.
    CrossrefSearch in Google Scholar
  • 2 Lord S, Galna B, Yarnall AJ, Coleman S, Burn D, Rochester L. Predicting first fall in newly diagnosed Parkinson’s disease: Insights from a fallnaïve cohort. Mov Disord 2016; 31 (12) 1829-36.
    CrossrefSearch in Google Scholar
  • 3 Bjornestad A, Pedersen KF, Tysnes O-B, Alves G. Clinical milestones in Parkinson’s disease: A 7-year population-based incident cohort study. Parkinsonism Relat Disord 2017; 42: 28-33.
    CrossrefSearch in Google Scholar
  • 4 Bloem BR, Marinus J, Almeida Q, Dibble L, Nieuwboer A, Post B. et al. Measurement instruments to assess posture, gait, and balance in Parkinson’s disease: Critique and recommendations. Mov Disord. 2016 e-pub..
    Search in Google Scholar
  • 5 Allen NE, Schwarzel AK, Canning CG. Recurrent falls in Parkinson’s disease: a systematic review. Parkinsons Dis 2013; 906274.
    Search in Google Scholar
  • 6 Hiorth YH, Alves G, Larsen JP, Schulz J, Tysnes O-B, Pedersen KF. Long-term risk of falls in an incident Parkinson’s disease cohort: the Norwegian ParkWest study. J Neurol 2017; 264 (02) 364-72.
    CrossrefSearch in Google Scholar
  • 7 Pickering RM, Grimbergen YA, Rigney U, Ashburn A, Mazibrada G, Wood B. et al. A meta-analysis of six prospective studies of falling in Parkinson’s disease. Mov Disord. 2007 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=17588236
    Search in Google Scholar
  • 8 Ashburn A, Stack E, Ballinger C, Fazakarley L, Fitton C. The circumstances of falls among people with Parkinson’s disease and the use of Falls Diaries to facilitate reporting. Disability and rehabilitation 2008; 30 (16) 1205-12.
    CrossrefSearch in Google Scholar
  • 9 Paul SS. et al. Fall-related hospitalization in people with Parkinson’s disease. Eur J Neurol März 2017; 24 (03) 523-9.
    Search in Google Scholar
  • 10 Kader M, Iwarsson S, Odin P, Nilsson MH. Fall-related activity avoidance in relation to a history of falls or near falls, fear of falling and disease severity in people with Parkinson’s disease. BMC Neurol 2016; 16: 84.
    CrossrefSearch in Google Scholar
  • 11 Van den Bos F, Speelman AD, Samson M, Munneke M, Bloem BR, Verhaar HJJ. Parkinson’s disease and osteoporosis. Age Ageing 2013; 42 (02) 156-62.
    CrossrefSearch in Google Scholar
  • 12 Bhattacharya RK, Dubinsky RM, Lai SM, Dubinsky H. Is there an increased risk of hip fracture in Parkinson’s disease? A nationwide inpatient sample. Mov Disord 2012; 27 (11) 1440-3.
    CrossrefSearch in Google Scholar
  • 13 Melton LJ, Leibson CL, Achenbach SJ, Bower JH, Maraganore DM, Oberg AL. et al. Fracture risk after the diagnosis of Parkinson’s disease: Influence of concomitant dementia. Mov Disord 2006; 21 (09) 1361-7.
    CrossrefSearch in Google Scholar
  • 14 Benzinger P, Rapp K, Maetzler W, König H-H, Jaensch A, Klenk J. et al. Risk for femoral fractures in Parkinson’s disease patients with and without severe functional impairment. PLoS ONE 2014; 09 (05) e97073.
    CrossrefSearch in Google Scholar
  • 15 Spottke AE, Reuter M, Machat O, Bornschein B, von Campenhausen S, Berger K. et al. Cost of illness and its predictors for Parkinson’s disease in Germany. Pharmacoeconomics 2005; 23 (08) 817-36.
    CrossrefSearch in Google Scholar
  • 16 Reese JP. et al. [Parkinson’s disease: cost-of-illness in an outpatient cohort]. Gesundheitswesen 2011; 73 (01) 22-9.
    Thieme ConnectSearch in Google Scholar
  • 17 Rahman S, Griffin HJ, Quinn NP, Jahanshahi M. Quality of life in Parkinson’s disease: the relative importance of the symptoms. Mov Disord 2008; 23 (10) 1428-34.
    CrossrefSearch in Google Scholar
  • 18 Schrag A, Hovris A, Morley D, Quinn N, Jahanshahi M. Caregiver-burden in parkinson’s disease is closely associated with psychiatric symptoms, falls, and disability. Parkinsonism Relat Disord 2006; 12 (01) 35-41.
    PubMedSearch in Google Scholar
  • 19 Chou KL. et al. Factors associated with falling in early, treated Parkinson’s disease: The NET-PD LS1 cohort. J Neurol Sci 2017; 377: 137-43.
    CrossrefSearch in Google Scholar
  • 20 Kerr GK, Worringham CJ, Cole MH, Lacherez PF, Wood JM, Silburn PA. Predictors of future falls in Parkinson disease. Neurology 2010; 75 (02) 116-24.
    CrossrefSearch in Google Scholar
  • 21 Heinzel S, Maechtel M, Hasmann SE, Hobert MA, Heger T, Berg D. et al. Motor dual-tasking deficits predict falls in Parkinson’s disease: A prospective study. Parkinsonism Relat Disord. 2016 e-pub..
    Search in Google Scholar
  • 22 Matinolli M, Korpelainen JT, Korpelainen R, Sotaniemi KA, Virranniemi M, Myllylä VV. Postural sway and falls in Parkinson’s disease: a regression approach. Mov Disord 2007; 22 (13) 1927-35.
    CrossrefSearch in Google Scholar
  • 23 Vervoort G, Nackaerts E, Mohammadi F, Heremans E, Verschueren S, Nieuwboer A. et al. Which Aspects of Postural Control Differentiate between Patients with Parkinson’s Disease with and without Freezing of Gait?. Parkinsons Dis 2013; 2013: 971480.
    Search in Google Scholar
  • 24 Schoneburg B, Mancini M, Horak F, Nutt JG. Framework for understanding balance dysfunction in Parkinson’s disease. Mov Disord 2013; 28 (11) 1474-82.
    CrossrefSearch in Google Scholar
  • 25 Van der Marck MA. et al. Consensus-based clinical practice recommendations for the examination and management of falls in patients with Parkinson’s disease. Parkinsonism Relat Disord 2014; 20 (04) 360-9.
    CrossrefPubMedSearch in Google Scholar
  • 26 Fietzek UM, Schroeteler F, Ziegler K, Ceballos-Baumann A. Gangstörungen. Nervenheilkunde 2007; 26 (10) 903-12.
    Thieme ConnectSearch in Google Scholar
  • 27 Fasano A, Canning CG, Hausdorff JM, Lord S, Rochester L. Falls in Parkinson’s disease: A complex and evolving picture. Mov Disord 2017; 32 (11) 1524-36.
    CrossrefSearch in Google Scholar
  • 28 Paul SS, Canning CG, Sherrington C, Lord SR, Close JCT, Fung VSC. Three simple clinical tests to accurately predict falls in people with Parkinson’s disease. Mov Disord 2013; 28 (05) 655-62.
    CrossrefSearch in Google Scholar
  • 29 Vance RC, Healy DG, Galvin R, French HP. Dual tasking with the timed “up & go” test improves detection of risk of falls in people with Parkinson disease. Phys Ther 2015; 95 (01) 95-102.
    CrossrefSearch in Google Scholar
  • 30 Keus S, Munneke M, Graziano M. European Physiotherapy Guideline for Parkinson’s disease 2014 – penultimate version for review. KNGF/ ParkinsonNet, the Netherlands [Internet]. 2014 www.ParkinsonNet.info
    Search in Google Scholar
  • 31 Franchignoni F, Horak F, Godi M, Nardone A, Giordano A. Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. J Rehabil Med 2010; 42 (04) 323-31.
    CrossrefSearch in Google Scholar
  • 32 Snijders AH, Haaxma CA, Hagen YJ, Munneke M, Bloem BR. Freezer or non-freezer: Clinical assessment of freezing of gait. Parkinsonism Relat Disord 2012; 18 (02) 149-54.
    CrossrefSearch in Google Scholar
  • 33 Ziegler K, Schroeteler F, Ceballos-Baumann AO, Fietzek UM. A new rating instrument to assess festination and freezing gait in Parkinsonian patients. Mov Disord 2010; 25 (08) 1012-8.
    CrossrefSearch in Google Scholar
  • 34 Petzinger GM, Fisher BE, McEwen S, Beeler JA, Walsh JP, Jakowec MW. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. Lancet Neurol 2013; 12 (07) 716-26.
    CrossrefSearch in Google Scholar
  • 35 Li F. et al. Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med 2012; 366 (06) 511-9.
    CrossrefSearch in Google Scholar
  • 36 Canning CG, Sherrington C, Lord SR, Close JCT, Heritier S, Heller GZ. et al. Exercise for falls prevention in Parkinson disease: a randomized controlled trial. Neurology 2015; 84 (03) 304-12.
    CrossrefPubMedSearch in Google Scholar
  • 37 Morris ME, Menz HB, McGinley JL, Watts JJ, Huxham FE, Murphy AT. et al. A Randomized Controlled Trial to Reduce Falls in People With Parkinson’s Disease. Neurorehabil Neural Repair 2015; 29 (08) 777-85.
    CrossrefSearch in Google Scholar
  • 38 Duncan RP, Earhart GM. Randomized controlled trial of community-based dancing to modify disease progression in Parkinson disease. Neurorehabil Neural Repair 2012; 26 (02) 132-43.
    CrossrefSearch in Google Scholar
  • 39 Lötzke D, Ostermann T, Büssing A. Argentine tango in Parkinson disease – a systematic review and meta-analysis. BMC Neurol 2015; 15: 226.
    CrossrefSearch in Google Scholar
  • 40 Strouwen C, Molenaar EALM, Keus SHJ, Münks L, Munneke M, Vandenberghe W. et al. Protocol for a randomized comparison of integrated versus consecutive dual task practice in Parkinson’s disease: the DUALITY trial. BMC Neurol 2014; 14: 61.
    CrossrefSearch in Google Scholar
  • 41 Strouwen C, Molenaar EALM, Münks L, Keus SHJ, Zijlmans JCM, Vandenberghe W. et al. Training dual tasks together or apart in Parkinson’s disease: Results from the DUALITY trial. Mov Disord 2017; 32 (08) 1201-10.
    CrossrefSearch in Google Scholar
  • 42 Mirelman A. et al. Addition of a non-immersive virtual reality component to treadmill training to reduce fall risk in older adults (V-TIME): a randomised controlled trial. Lancet 2016; 388 10050 1170-82.
    CrossrefSearch in Google Scholar
  • 43 Conradsson D, Löfgren N, Nero H, Hagströmer M, Ståhle A, Lökk J. et al. The effects of highly challenging balance training in elderly with parkinson’s disease: A randomized controlled trial. Neurorehabil Neural Repair 2015; 29 (09) 827-36.
    CrossrefSearch in Google Scholar
  • 44 Conradsson D, Löfgren N, Ståhle A, Hagströmer M, Franzén E. A novel conceptual framework for balance training in Parkinson’s disease-study protocol for a randomised controlled trial. BMC 2012; 12: 111.
    Search in Google Scholar
  • 45 Jöbges M, Heuschkel G, Pretzel C, Illhardt C, Renner C, Hummelsheim H. Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2004; 75 (12) 1682-7.
    CrossrefSearch in Google Scholar
  • 46 Protas EJ, Mitchell K, Williams A, Qureshy H, Caroline K, Lai EC. Gait and step training to reduce falls in Parkinson’s disease. NeuroRehabilitation 2005; 20 (03) 183-90.
    Search in Google Scholar
  • 47 Smania N, Corato E, Tinazzi M, Stanzani C, Fiaschi A, Girardi P. et al. Effect of balance training on postural instability in patients with idiopathic Parkinson’s disease. Neurorehabil Neural Repair 2010; 24 (09) 826-34.
    CrossrefSearch in Google Scholar
  • 48 Goodwin VA, Richards SH, Henley W, Ewings P, Taylor AH, Campbell JL. An exercise intervention to prevent falls in people with Parkinson’s disease: a pragmatic randomised controlled trial. J Neurol Neurosurg Psychiatr 2011; 82 (11) 1232-8.
    CrossrefSearch in Google Scholar
  • 49 Allen NE, Canning CG, Sherrington C, Lord SR, Latt MD, Close JCT. et al. The effects of an exercise program on fall risk factors in people with Parkinson’s disease: a randomized controlled trial. Mov Disord 2010; 25 (09) 1217-25.
    CrossrefSearch in Google Scholar
  • 50 Nieuwboer A. Cueing for freezing of gait in patients with Parkinson’s disease: a rehabilitation perspective. Mov Disord 2008; 23 (Suppl. 02) S475-481.
    CrossrefPubMedSearch in Google Scholar
  • 51 Fietzek UM, Schroeteler FE, Ziegler K, Zwosta J, Ceballos-Baumann AO. Randomized cross-over trial to investigate the efficacy of a two-week physiotherapy programme with repetitive exercises of cueing to reduce the severity of freezing of gait in patients with Parkinson’s disease. Clin Rehabil. 2014 e-pub..
    Search in Google Scholar
  • 52 Schroeteler F, Ceballos-Baumann A. Münchner Anti Freezing Training (MAFT). Nervenheilkunde 2016; 34: 198-204.
    Thieme ConnectSearch in Google Scholar
  • 53 Schroeteler F, Ziegler K, Fietzek UM, Ceballos-Baumann A. [Freezing of gait: Phenomenology, pathophysiology, and therapeutic approaches.]. Der Nervenarzt. 2009 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=19224189
    Search in Google Scholar
  • 54 Morris ME, Iansek R, Kirkwood B. A randomized controlled trial of movement strategies compared with exercise for people with Parkinson’s disease. Mov Disord 2009; 24 (01) 64-71.
    CrossrefSearch in Google Scholar
  • 55 Schoneburg B, Mancini M, Horak F, Nutt JG. Framework for understanding balance dysfunction in Parkinson’s disease. Mov Disord Off J Mov Disord Soc 2013; 28: 1474-82.
    CrossrefSearch in Google Scholar