Konzepte zu Diagnose, Verlaufs- und Sturzrisikobeurteilung bei neurologischen Gangstörungen

Zusammenfassung

Die quantitative Ganganalyse findet zunehmend Einsatz bei der Diagnose, Verlaufsbeurteilung und Risikostratifizierung von neurologischen Gangstörungen. Dabei bleibt oft unklar, welche Messtechnik, Untersuchungsbedingungen und Gangmerkmale geeignet sind, um bestimmte klinische Fragestellungen zu beantworten. Ziel dieses Überblicksartikels ist es, allgemein anwendbare Konzepte und Strategien für die Testung, Analyse und Interpretation der Gangfunktion im klinischen Kontext vorzustellen und ihre Anwendung nah an der klinischen Praxis zu illustrieren. Der erste Abschnitt des Artikels gibt einen Überblick über derzeit verfügbare stationäre und mobile Messtechnologien, die eine Testung von Gang im klinischen Bereich und eine kontinuierliche Erfassung von Mobilität im Alltag der Patienten ermöglichen. Zudem werden Strategien zur Auswahl geeigneter Untersuchungsprotokolle diskutiert und Konzepte vorgestellt, die die Parametrisierung von Gang vereinfachen. Die anschließenden Abschnitte widmen sich konkreten klinischen Anwendungsfeldern der quantitativen Ganganalyse: Anhand von Fallbeispielen aus der aktuellen Studienliteratur wird dargestellt, (1) wie spezifische Muster des Gangbefunds Orientierungspunkte für die Differenzialdiagnose bieten und (2) wie quantitative Gangmerkmale die Früherkennung, Verlaufsbeurteilung und das Therapiemonitoring bei neurologischen Gangstörungen unterstützen können. Abschließend wird (3) der Beitrag von stationärer Gangtestung und mobiler Mobilitätserfassung für die Sturzrisikoprognose bei Patienten mit neurologischen Gangstörungen diskutiert.

Abstract

Quantitative gait assessment is increasingly applied in the diagnosis, disease monitoring, and risk stratification of neurological gait disorders. However, it is unclear, which measurement approaches, examination conditions, and gait characteristics are appropriate for answering specific clinical questions. The aim of this review was to provide generally applicable concepts and strategies for the measurement, analysis, and interpretation of gait function in the clinical context and to discuss their implementation in clinical practice. The first part of the article introduces currently available stationary and mobile measurement technologies that enable assessment of gait in clinical environments and to continuously track patients’ mobility in the context of everyday life. Furthermore, the selection of adequate examination conditions and concepts that facilitate the parametrization of gait are discussed. The subsequent parts of the article address concrete clinical fields of application for quantitative gait analysis. With the help of exemplary cases from current research, the following issues are dicussed: (1) how specific patterns in gait assessments can guide differential diagnosis; (2) how quantitative gait measures can support the early diagnosis as well as the monitoring of disease progression and intervention outcomes in neurological gait disorders and finally, (3) the contribution of stationary gait and mobile mobility assessment for fall risk prognosis in patients with neurological gait impairments.

Schlüsselwörter

Gangstörung - apparative Ganganalyse - Früherkennung - Verlaufsbeurteilung - Sturzrisiko

Key words

Gait disorder - instrument-based gait analysis - early diagnosis - disease monitoring - fall risk

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