Physiotherapeutische Massnahmen bei degenerativen

14.04.2016
Degenerative Veränderungen: Grundlagen und prophylaktische Massnahmen
Physiotherapeutische Massnahmen bei degenerativen
Veränderungen der Muskulatur
Eling D. de Bruin
„Die Spiele der Jugend sind kein müßiger Zeitvertreib, sondern sie gehören zu den wichtigsten
Erziehungsmitteln, bei deren Auswahl und Wechsel der Zweck der harmonischen Ausbildung des
Körpers und Geistes im Vordergrund stehen sollte.“ Wilhelm Max Wundt (1832 - 1920).
• [1] Theoretischer Hintergrund; degenerative Veränderungen
• Langsameres Gehen & Stürze
• [2] Physiotherapeutische Massnahmen
• Systematic Review
• Ausgewählte Studien
• [3] Beispiele innovative physiotherapeutische Massnahmen
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Definition Physical Therapists
• «Physical therapists (PTs) are highly-educated,
licensed health care professionals who can help
patients reduce pain and improve or restore mobility
………» (http://www.apta.org/AboutPTs/)
Adapted from Hausdorff et al. J Appl Physiol. 90: 2117-2129, 2001
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•
•
•
•
<0.6 m/s = ernsthaft abnormal
0.6 to 1.0 m/s = leicht abnormal
1.0 to 1.4 = normal
1.4 oder höher = überlegen
http://lowerextremityreview.com/article/self-selected-gait-speed-a-critical-clinical-outcome
16 Ostir GV et al. Arch Intern Med 2012;172(4):353-358
24 Kennedy D et al. Phys Ther 2008;88(1):22-32
23 Studenski S et al. J Am Geriatr Soc 2003;51(3):314-322
17, 18. Rabadi MH & Blau A. Neurorehabil Neural Repair 2005;19(1):20-26 & Bohannon R. Presented at NIH Toolbox Conference, Bethesda,
MD, October 2008
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Lusardi M, Pellecchia GL, Schulman M. Functional
performance in community living older adults. J
Geriatr Phys Ther. 2003;26(3):14-22
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• decrease in the number
and atrophy of type II
skeletal fibres
• type I fibres are more
preserved
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Muscle of Average
Healthy Adult
Muscle After
Sarcopenia Occurs
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Quadriceps strength
thresholds for
walking: minimum
required knee
extension strength
for walking (1.22
m/s) = 4 W/kg
Observed threshold ( ) of leg extension peak isometric torque to body weight ratio (STR/WT) by age
for subjects observed to have no difficulty, some difficulty, and a lot of difficulty on the chair rise activity.
Lori L. Ploutz-Snyder et al. J Gerontol A Biol Sci Med Sci
2002;57:B144-B152
The Gerontological Society of America
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Observed threshold ( ) of leg extension peak isometric torque to body weight ratio (STR/WT) by
age for subjects measured to be able or unable to walk at 1.22 m/s.
Lori L. Ploutz-Snyder et al. J Gerontol A Biol Sci Med Sci
2002;57:B144-B152
The Gerontological Society of America
Observed threshold ( ) of leg extension peak isometric torque to body weight ratio (STR/WT) by
age for subjects observed to have no difficulty or difficulty ascending stairs.
Lori L. Ploutz-Snyder et al. J Gerontol A Biol Sci Med Sci
2002;57:B144-B152
The Gerontological Society of America
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Observed threshold ( ) of leg extension peak isometric torque to body weight ratio (STR/WT) by
age for subjects observed to have no difficulty or difficulty descending stairs.
Lori L. Ploutz-Snyder et al. J Gerontol A Biol Sci Med Sci
2002;57:B144-B152
The Gerontological Society of America
• Recommendation 7. Strength training may be
included in addition to balance training
“…, the inclusion of strength training does not seem to be
crucial for an effect of exercise on falls,….”
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The age-related loss of muscle strength is weakly associated with the loss of
muscle mass.
Brian C. Clark , Todd M. Manini. What is dynapenia? Nutrition Volume 28, Issue
5 2012 495 – 503.
Tolea MI, Galvin JE. Sarcopenia and impairment in cognitive and physical performance. Clin Interv Aging. 2015 Mar
30;10:663-71
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Survival curves illustrating the percent of subjects who did not fall as a function of time and
executive function (EF).
Mirelman A, Herman T, Brozgol M, Dorfman M, et al. (2012) Executive Function and Falls in Older Adults: New Findings from a FiveYear Prospective Study Link Fall Risk to Cognition. PLoS ONE 7(6): e40297. doi:10.1371/journal.pone.0040297
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0040297
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Proposed biologic mechanisms contributing to dynapenia (the age-associated loss of strength).
It shows the influence of multiple factors that may lead to muscle weakness in the elderly.
Adapted from J Gerontol A Biol Sci Med Sci 2008. 63: 829-34
Conceptual model of how nervous and muscle system impairments lead to
dynapenia
Brian C. Clark , Todd M. Manini. What is dynapenia? Nutrition Volume 28, Issue
5 2012 495 – 503.
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FAILURE OF EFFICIENT BRAIN-MUSCLES COMMUNICATION IN DYNAPENIA: A NEUROGENIC
DRIVEN SYNDROME?
TM Manini, 2013
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Neurophysiologische mechanismen
(dynapenia):
• Cortex
• Aging ► ▼motor cortex
excitability/cortical plasticity ► muscle
performance▼
• Spinal Cord
• Aging ► ▼ General excitability spinal
reflexes ► Δ motor unit discharge ► ▼
muscle functional properties
• Muscle
• ▼ Maximal motor unit firing rates
Scott. Nature Reviews Neuroscience 5, 532-546; 2004
Clark & Manini. Nutrition 28(5), 2012: 495 – 503
Exergaming:
Bild dividat: www.dividat.ch
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• Bilateral reduction in prefrontal brain activity; preferred &
fast locomotion (larger effects in video game)
• Increase in hemispheric PFC activity asymmetry
• Increased differentiation in PFC activity related to
walking speed
• Adaptations resemble more trained or young adult-like
brain functions
• Prefrontal adaptations correlate with improved
performance in executive functions and processing
speed
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50%
Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.
Weighted mean differences (95% CI) of the effect
immediately after intervention of substituting some or
all of standard rehabilitation (SR) with virtual reality
based rehabilitation (VRBR) on walking speed,
pooling data from seven trials (n = 138).
Weighted mean differences (95% CI) of the effect
beyond the end of the intervention period of
substituting some or all of standard rehabilitation (SR)
with virtual reality based rehabilitation (VRBR) on
walking speed, pooling data from three trials.
http://dx.doi.org/10.1016/j.jphys.2015.05.017
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77%
“Man does not cease to play because he grows old.
Man grows old because he ceases to play”
George Bernard Shaw
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