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manuelletherapie 2009; 13(3): 117-123
DOI: 10.1055/s-0028-1109540
aus der Praxis – für die Praxis

© Georg Thieme Verlag KG Stuttgart · New York

Posturale Instabilität bei Morbus Parkinson

Ursachen, Erscheinungsformen, Evaluation und TherapieansätzePostural Instability in Parkinsons’s DiseaseCauses, Manifestations, Evaluation and Therapy ApproachesS. Turbanski1
  • 1Institut für Sportwissenschaften, Johann Wolfgang Goethe Universität Frankfurt am Main
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Publication History

Manuskript eingetroffen: 20.10.2008

Manuskript akzeptiert: 20.1.2009

Publication Date:
15 July 2009 (online)

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Zusammenfassung

Die posturale Instabilität stellt ein klinisches Kardinalsymptom bei Morbus Parkinson dar, das die Mobilität der Patienten beeinträchtigt und ihr Sturzrisiko erhöht. Da die klinische Erfassung in der Kritik steht und die Defizite der posturalen Kontrolle medikamentös nicht behandelt werden können, gewinnt diese Problematik in der motorischen Bewegungsforschung sowie in der Physio- und Sporttherapie an Bedeutung.

Für eine adäquate Messung und eine optimierte Therapie der posturalen Instabilität sind Kenntnisse über die Ursachen, Erscheinungsformen, Evaluation und bisherige Therapieansätze notwendig. Diese Punkte werden im vorliegenden Übersichtsartikel dargestellt und diskutiert.

Abstract

Postural instability is a clinical cardinal symptom in Parkinsons’s disease which affects the patients’ mobility and increases their risk of falls. As clinical measurement of postural instability is under criticism and postural control deficits cannot be treated by medication this problem has gaines more importance in movement research as well as in physiotherapy and sports therapy.

Appropriate measurement and optimised therapy of postural instability necessitate knowledge about causes, manifestations, evaluation and previous therapy approaches. This review portrays and discusses these issues.

Schlüsselwörter

Morbus Parkinson - posturale Instabilität - Propriozeption

Key words

Parkinsons’s disease - postural instabilty - proprioception

Literatur

  • 1 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
    Search in Google Scholar
  • 2 Allum J H, Carpenter M G, Honegger F. et al . Age-dependent variations in the directional sensitivity of balance corrections and compensatory arm movements in man.  J Physiol. 2002;  542 643-663
    Search in Google Scholar
  • 3 Ashburn A, Stack E, Pickering R M. et al . A community-dwelling sample of people with Parkinson’s disease: characteristics of fallers and non-fallers.  Age and Aging. 2001;  30 47-52
    Search in Google Scholar
  • 4 Bennett D A, Beckett L A, Murray A M. et al . Prevalence of Parkinsonian Signs and Associated Mortality in a Community Population of Older People.  N Engl J Med. 1996;  334 71-76
    Search in Google Scholar
  • 5 Berg K O, Wood-Dauphinee S L, Williams J L. et al . Measuring balance in the elderly: validation of an instrument.  Can J Public Health. 1992;  83 (Suppl 2) S7-S11
    Search in Google Scholar
  • 6 Bloem B R, Beckley D J, Van Dijk J G. et al . Influence of dopaminergic medication on automatic postural responses and balance impairment in Parkinson’s disease.  Mov Disord. 1996;  11 509-521
    Search in Google Scholar
  • 7 Bloem B R, Beckley D J, Van Hilten B J. et al . Clinimetrics of postural instability in Parkinson’s disease.  J Neurol. 1998;  245 669-673
    Search in Google Scholar
  • 8 Bloem B R, Beckley D J, Dijk J G. Are automatic postural responses in patients with Parkinson’s disease normal to their stooped posture?.  Exp Brain Res. 1999;  124 481-488
    Search in Google Scholar
  • 9 Bloem B R, Grimbergen Y AM, Cramer van M. et al . Prospective assessment of falls in Parkinson’s disease.  J Neurol. 2001;  248 950-958
    Search in Google Scholar
  • 10 Bloem B r, Valkenburg V V, Slabbekoorn M. et al . The Multiple Task Test – Development and normal strategies.  Gait and Posture. 2001;  14 191-202
    Search in Google Scholar
  • 11 Bloem B R, Grimbergen Y AM, 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
    Search in Google Scholar
  • 12 Bronstein A M, Hood J D, Gresty M A. et al . Visual control of balance in cerebellar and parkinsonian syndromes.  Brain. 1990;  113 767-779
    Search in Google Scholar
  • 13 Bronte-Stewart H M, Minn A Y, Rodrigues K. et al . Postural instability in idiopathic Parkinson’s disease: the role of medication and unilateral pallidotomy.  Brain. 2002;  9 2100-2112
    Search in Google Scholar
  • 14 Brown P, Chen C C, Wang S. et al . Involvement of human basal ganglia in offline feedback control of voluntary movement.  Curr Biol. 2006;  16 2129-2134
    Search in Google Scholar
  • 15 Carpenter M G, Allum J HJ, Honegger F. Directional sensitivity of stretch reflexes and balance corrections for normal subjects in the roll and pitch planes.  Exp Brain Res. 1999;  129 93-113
    Search in Google Scholar
  • 16 Carpenter M G, Allum J HJ, Honegger F. et al . Postural abnormalities to multidirectional stance perturbations in Parkinson’s disease.  J Neurol Neurosurg Psychiatry. 2004;  75 1245-1254
    Search in Google Scholar
  • 17 Chong R KY, Jones C L, Horak F B. Parkinson’s disease impairs the ability to change set quickly.  J Neurol Sci. 2000;  175 57-70
    Search in Google Scholar
  • 18 Cody F W, MacDermott N, Matthews P B. et al . Observations on the genesis of stretch reflexes in Parkinson’s disease.  Brain. 1986;  109 229-249
    Search in Google Scholar
  • 19 Collins J J, De Luca C J. The effects of visual input on open-loop and closed-loop postural control mechnanisms.  Exp Brain Res. 1995;  103 151-163
    Search in Google Scholar
  • 20 Comella C L, Stebbins G T, Brown-Toms N. et al . Physical therapy and Parkinson’s disease: a controlled clinical trial.  Neurology. 1994;  44 376-378
    Search in Google Scholar
  • 21 Demirci M, Grill S, McShane L. et al . A mismatch between kinesthetic and visual perception in Parkinson’s disease.  Ann Neurol. 1997;  41 781-788
    Search in Google Scholar
  • 22 Dietz V, Berger W, Hostmann G A. Posture in Parkinson’s disease: impairment of reflexes and programming.  Ann Neurol. 1988;  24 660-669
    Search in Google Scholar
  • 23 Dietz V, Zijlstra W, Assaiante C. et al . Balance control in Parkinson’s disease.  Gait and Posture. 1993;  1 77-84
    Search in Google Scholar
  • 24 Dimitrova D, Horak F B, Nutt J G. Postural Muscle Response to Multidirectional Translations in Patients With Parkinson’s Diesase.  J Neurophysiol. 2004;  91 489-501
    Search in Google Scholar
  • 25 Ebersbach G, Müller J, Soer M. et al . Quantitative measurement of postural instability in Parkinson’s disease.  Mov Disord. 2000;  15 (Suppl 3) 74
    Search in Google Scholar
  • 26 Ellis T, Goede C J, Feldman R G. et al . Efficacy of a physical therapy program in patients with Parkinson’s disease: a randomized controlled trial.  Arch Phys Med Rehabil. 2005;  86 626-632
    Search in Google Scholar
  • 27 Van Emmerik R E, Wagenaar R C, Winogrodzka de A. et al . Identification of axial rigidity during locomotion in Parkinson’s disease.  Arch Phys Med Rehabil. 1999;  80 186-191
    Search in Google Scholar
  • 28 Frank J S, Horak F B, Nutt J. Centrally Initiated Postural Adjustments in Parkinsonian Patients On and Off Levodopa.  J Neurophysiol. 2000;  84 2440-2448
    Search in Google Scholar
  • 29 Gardner M M, Robertson M C, Campbell A J. Exercise in preventing falls and fall-related injuries in older people: a review of randomised controlled trials.  Br J Sports Med. 2000;  34 7-17
    Search in Google Scholar
  • 30 Gerlach M, Reichmann H, Riederer P. Die Parkinson-Krankheit. Grundlagen – Klinik – Therapie. Wien; Springer 2003
    Search in Google Scholar
  • 31 Gray P, Hildebrand K. Fall risk factors in Parkinson’s disease.  J Neurosci Nurs. 2000;  32 222-228
    Search in Google Scholar
  • 32 Grimbergen Y, Munneke M, Bloem B R. Falls in Parkinson’s disease.  Current Opinion in Neurology. 2004;  17 405-415
    Search in Google Scholar
  • 33 Guttman M, Kish S J, Furukawa Y. Current concepts in the diagnosis and management of Parkinson’s disease.  CMAJ. 2003;  168 293-301
    Search in Google Scholar
  • 34 Gwinn-Hardy K. Genetics of Parkinsonism.  Mov Disord. 2002;  17 645-656
    Search in Google Scholar
  • 35 Hirsch M A, Toole T, Maitland C G. et al . The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson’s disease.  Arch Phys Med Rehabil. 2003;  84 1109-1117
    Search in Google Scholar
  • 36 Horak F B, Nutt J G, Nashner L M. Postural inflexibility in parkinsonian subjects.  J Neurol Sci. 1992;  111 46-58
    Search in Google Scholar
  • 37 Horak F B, Frank J, Nutt J. Effects of dopamine on postural control in parkinsonian subjects: scaling, set and tone.  J Neurophysiol. 1996;  75 2380-2396
    Search in Google Scholar
  • 38 Horak F B, Dimitrova D, Nutt J G. Direction-specific postural instability in subjects with Parkinson’s disease.  Exp Neurol. 2005;  193 504-521
    Search in Google Scholar
  • 39 Jacobs J V, Horak F B. Abnormal proprioceptive-motor integration contributes to hypometric postural responses of subjects with Parkinson’s disease.  Neuroscience. 2006;  141 999-1009
    Search in Google Scholar
  • 40 Jacobs J V, Horak F B, Tran V K. et al . An alternative clinical postural stability test for patients with Parkinson’s disease.  J Neurol Neurosurg Psychiatry. 2006;  77 322-326
    Search in Google Scholar
  • 41 Jankovic J, McDermott M, Carter J. et al . Variable expression of Parkinson’s disease: a base-line analysis of the DATATOP cohort. The Parkinson Study Group.  Neurology. 1990;  40 1529-1534
    Search in Google Scholar
  • 42 Jankovic J, Rajout A H, McDermott M P. et al . The Evolution of Diagnosis in Early Parkinson’s Disease.  Arch Neurol. 2000;  57 369-372
    Search in Google Scholar
  • 43 Jankovic J. Levodopa – strengths and weaknesses.  Neurology. 2002;  58 (Suppl 1) 19-32
    Search in Google Scholar
  • 44 Jöbges M, Heuschkel G, Pretzel C. et al . Repetitive training of compensatory steps: a therapeutic approach for postural instability in Parkinson’s disease.  J Neurol Neurosurg Psychiatry. 2004;  75 1682-1687
    Search in Google Scholar
  • 45 Jobst E E, Melnick M E, Byl N N. et al . Sensory perception in Parkinson’s disease.  Arch Neurol. 1997;  54 450-454
    Search in Google Scholar
  • 46 Khudados E, Cody F WJ, O’Boyle D J. Proprioceptive regulation of voluntary ankle movements, demonstrated using muscle vibration is impaired by Parkinson’s disease.  J Neurol Neurosurg Psychiatry. 1999;  67 504-510
    Search in Google Scholar
  • 47 Klawans H L. Individual manifestations of Parkinson’s disease after ten or more years of levodopa.  Mov Disord. 1986;  1 187-192
    Search in Google Scholar
  • 48 Klockgether T, Borutta M, Rapp H. et al . A defect of kinesthesia in Parkinson’s disease.  Mov Disord. 1995;  10 460-465
    Search in Google Scholar
  • 49 Koller W, Olanow C, Shoulson I. Variable expression of Parkinson’s disease. A baseline expression of the DATA-TOP study cohort.  Neurol. 1990;  40 1529-1534
    Search in Google Scholar
  • 50 Lang A E, Lozano A M. Parkinson’s disease.  N Engl J Med. 1998;  339 1044-1053, 1130 – 1143
    Search in Google Scholar
  • 51 Lord S R, Clark R D, Webster I W. Postural stability and associated physiological factors in a population of aged persons.  J Gerontol. 1991;  46 69-76
    Search in Google Scholar
  • 52 Lord S R, Rogers M W, Howland A. et al . Lateral stability, sensorimotor function and falls in older people.  J Am Geriatric Soc. 1999;  47 1077-1081
    Search in Google Scholar
  • 53 Marchese R, Bove M, Abbruzzese G. Effect of Cognitive and Motor Tasks on Postural Stability in Parkinson’s disease: A Posturographic Study.  Mov Disorder. 2003;  18 652-658
    Search in Google Scholar
  • 54 Marsden C D, Obeso J A. The functions of the basal ganglia and the paradox of stereotaxic surgery in Parkinson’s disease.  Brain. 1994;  117 877-897
    Search in Google Scholar
  • 55 Mitchell S L, Collins J J, De Luca C J. et al . Open-loop and closed-loop postural control mechanisms in Parkinson’s disease: increased mediolateral activity during quiet standing.  Neurosci Lett. 1995;  197 133-136
    Search in Google Scholar
  • 56 Moore A P. Impaired sensorimotor integration in parkinsonism and dyskinesia: a role of corollary discharges.  J Neurol Neurosurg Psychiatry. 1987;  50 544-552
    Search in Google Scholar
  • 57 Morris S, Morris M E, Iansek R. Performance on clinical tests of balance in Parkinson’s disease.  Phys Ther. 1998;  81 810-818
    Search in Google Scholar
  • 58 Morris M E. Movement Disorders in People with Parkinson’s Disease: A Model for Physical Therapy.  Physical Therapy. 2000;  80 578-597
    Search in Google Scholar
  • 59 Morris M E, Iansek R, Smithson F. et al . Postural instability in Parkinson’s disease: a comparison with and without a concurrent task.  Gait and Posture. 2000;  12 205-216
    Search in Google Scholar
  • 60 Nardone A, Siliotto R, Grasso M. et al . Influence of aging on leg muscle reflex response to stance perturbations.  Archives of Physical Medicine and Rehabilitation. 1995;  76 158-165
    Search in Google Scholar
  • 61 Newstead A H, Hinman M R, Tomberlini J A. Reliability of the Berg Balance Scale and Master Limits of Stability Test for individuals with Brain Injury.  Journal of Neurologic Physical Therapy. 2005;  29 18-23
    Search in Google Scholar
  • 62 O’Suilleabhain P, Bullard J, Dewey R B. Proprioception in Parkinson’s disease is actually depressed by dopaminergic medications.  J Neurol Neurosurg Psychiatry. 2001;  71 607-610
    Search in Google Scholar
  • 63 Parkinson J. An essay on the shaking palsy. London; Sherwood, Neely & Jones 1817
    Search in Google Scholar
  • 64 Pellecchia M T, Grasso A, Biancardi L G. et al . Physical therapy in Parkinson’s disease: an open long-term rehabilitation trial.  J Neurol. 2004;  251 595-598
    Search in Google Scholar
  • 65 Perrin P P, Gauchard G C, Perrot C. et al . Effects of physical and sporting activities on balance control in elderly people.  Br J Sports Med. 1999;  33 121-126
    Search in Google Scholar
  • 66 Peterka R J, Loughlin P J. Dynamic regulation of sensorimotor integration in human postural control.  J Neurophysiol. 2004;  91 410-423
    Search in Google Scholar
  • 67 Reuter I, Engelhardt M, Stecker K. et al . Therapeutic value of exercise training in Parkinson’s disease.  Med Sci Sports Exerc. 1999;  11 1544-1549
    Search in Google Scholar
  • 68 Rickards C, Cody F WJ. Proprioceptive control of wrist movements in Parkinson’s disease.  Brain. 1997;  120 977-990
    Search in Google Scholar
  • 69 Robert-Warrior D, Overby A, Jankovic J. et al . Postural control in Parkinson’s disease after unilateral posteroventral pallidotomy.  Brain. 2000;  123 2141-2149
    Search in Google Scholar
  • 70 Rocchi L, Chiari L, Cappello A. et al . Identification of distinct characteristics of postural sway in Parkinson’s disease: a feature selection procedure based on principal component analysis.  Neurosci Lett. 2006;  394 140-145
    Search in Google Scholar
  • 71 Schieppati M, Hugon M, Grasso M. et al . The limits of equilibrium in young and elderly normal subjects and in parkinsonians.  Electroencephalogr Clin Neurophysiol. 1994;  93 286-298
    Search in Google Scholar
  • 72 Schrag A, Jahanshahi M, Quinn N. What contributes to quality of life in patients with Parkinson’s disease?.  J Neurol Neurosurg Psychiatry. 2000;  69 308-312
    Search in Google Scholar
  • 73 Smithson F, Morris M E, Jansek R. Performance on clinical tests of balance in Parkinson’s disease.  Phy Ther. 1998;  8 577-592
    Search in Google Scholar
  • 74 Stankovic I. The effects of physical therapy on balance of patients with Parkinson’s disease.  International Journal of Rehabilitation Research. 2004;  27 53-57
    Search in Google Scholar
  • 75 Tanner C M, Ottman R, Goldman S M. et al . Parkinson’s disease in twins: an etiologic study.  JAMA. 1999;  281 341-346
    Search in Google Scholar
  • 76 Tinetti M E. Performance-oriented assessment of mobility problems in elderly patients.  J Am Geriatr Soc. 1986;  34 119-126
    Search in Google Scholar
  • 77 Tinetti M E. Preventing Falls in Elderly People.  N Engl J Med. 2003;  348 42-49
    Search in Google Scholar
  • 78 Tinetti M E, Gordon C, Sogolow E. et al . Fall-risk evaluation and management: challenges in adopting geriatric care practices.  Gerontologist. 2006;  46 717-725
    Search in Google Scholar
  • 79 Trenkwalder C, Paulus W, Krafczyk S. et al . Postural stability differentiates „lower body” from idiopathic parkinsonism.  Acta Neurol Scand. 1995;  91 444-452
    Search in Google Scholar
  • 80 Turbanski S, Haas C T, Schmidtbleicher D. Effects of random whole-body vibration on postural stability in Parkinson’s disease.  Research in Sports Medicine: An International Journal. 2005;  3 243-256
    Search in Google Scholar
  • 81 Turbanski S. Zur posturalen Kontrolle bei Morbus Parkinson – Biomechanische Diagnose und Training [Dissertation]. Frankfurt/M; Universität Frankfurt 2006
    Search in Google Scholar
  • 82 Turbanski S, Haas C T, Schmidtbleicher D. Comparison of biomechanical and clinical assessment of postural stability in Parkinson’s disease.  Clinical Neurophysiology. 2006;  4 E104-E105
    Search in Google Scholar
  • 83 Turbanski S, Haas C T, Schmidtbleicher D. Short-term effects of sensorimotor training on postural reflexes in parkinsonian subjects. Abstractbook. 11th Annual Congress ECSS Congress Lausanne; 2006: 264-265
    Search in Google Scholar
  • 84 Visser M, Marinus J, Bloem B R. et al . Clinical tests for the evaluation of postural instability in patients with Parkinson’s disease.  Arch Phys Med Rehabil. 2003;  84 1669-1674
    Search in Google Scholar
  • 85 Waterston J A, Hawken M B, Tanyeri S. et al . Influence of sensory manipulation on postural control in Parkinson’s disease.  J Neurol Neurosurg Psychiatry. 1993;  56 1276-1281
    Search in Google Scholar
  • 86 Wood B H, Bilclough J A, Bowron A. et al . Incidence and prediction of falls in Parkinson’s disease: a prospective and multidisciplinary study.  J Neurol Neurosurg Psychiatry. 2002;  72 721-725
    Search in Google Scholar
  • 87 Zia S, Cody F, O’Boyle D. Joint position sense is impaired by Parkinson’s disease.  Ann Neurol. 2000;  47 218-228
    Search in Google Scholar

Dr. Stephan Turbanski

Institut für Sportwissenschaften, Johann Wolfgang Goethe Universität Frankfurt am Main

Ginnheimer Landstr. 39

60487 Frankfurt

Email: turbanski@sport.uni-frankfurt.de