Kemoun G, Defebvre L, Watelain E, Guieu J-D, Destée A
Service de Médecine Physique et de Réadaptation, CHU de Poitiers.
Rev Neurol (Paris). 2003 Nov;159(11):1028-37.
Falls are a dramatic consequence of the age-related gait disorders. There are few prospective studies on falls predictive of the biomechanical features of gait. According to the literature, there are similarities between the gait observed in older people and in parkinsonian subjects. The objective of this study was to apply multiparametric gait analysis to demonstrate changes of the neuromotor gait pattern connected with falls. This prospective study included two groups of 16 subjects aged more than 60 years, who had not fallen during the previous year. One group included 16 minimally disabled parkinsonian patients off drugs, and the other group 16 healthy people. Gait recordings were obtained with a three-dimensional optoelectronic movement analysis system coupled with 2 force platforms in all persons who were followed for 1 year to collect data on all new events, particularly falls. Data analysis concerned spatiotemporal stride and three-dimensional power peaks developed in each lower limb joint. Cluster analysis of the 32 persons was used to determine various infraclinic neuromotor gait patterns. A post hoc analysis of variance was then applied to identify discriminating parameters. Three groups of subjects were identified with 3 different neuromotor gait patterns, independently of the presence of Parkinson disease. There were no fallers in first group (n=18). The second group (n=8) had 20 p.cent fallers and the third group (n=4) 100 p.cent fallers. The groups differed by 4 spatiotemporal parameters and 3 joint power peaks in the sagittal plane. Functional capacity was good in the first group with no falls recorded. This group of subjects had characteristics reported in the literature corresponding to a category of persons who compensate well for the phenomena of aging. Functional capacity was intermediary in the second group (20 p. cent were fallers). The kinematic pattern appeared to be less successful, revealing a tendency for stiff posture. The third group (100 p. cent fallers) exhibited inferior functional capacity. In this group, the kinematic pattern appeared to be disrupted. The subjects were unable to adapt satisfactorily to situations other than by stereotypical neuromotor reactions. In conclusion this study demonstrated a close determinism between physiological neuromotor aging and Parkinson's disease. The prospective follow-up demonstrated that falls that occurred were related to changes in neuromotor gait patterns. Three phases of gait pattern were also identified from minimal to major risk of falls.
跌倒是与年龄相关的步态障碍的一个显著后果。关于跌倒对步态生物力学特征预测作用的前瞻性研究较少。根据文献，老年人和帕金森病患者的步态存在相似之处。本研究的目的是应用多参数步态分析来证明与跌倒相关的神经运动步态模式的变化。这项前瞻性研究包括两组16名年龄超过60岁且前一年未发生跌倒的受试者。一组包括16名未服药的轻度残疾帕金森病患者，另一组为16名健康人。所有受试者均使用三维光电运动分析系统结合2个测力平台进行步态记录，随访1年以收集所有新事件的数据，尤其是跌倒情况。数据分析涉及时空步幅以及每个下肢关节产生的三维功率峰值。对这32名受试者进行聚类分析以确定各种亚临床神经运动步态模式。然后应用事后方差分析来识别鉴别参数。确定了三组具有三种不同神经运动步态模式的受试者，与帕金森病的存在无关。第一组（n = 18）无跌倒者。第二组（n = 8）有20%的跌倒者，第三组（n = 4）有100%的跌倒者。三组在4个时空参数和矢状面的3个关节功率峰值方面存在差异。第一组功能能力良好，未记录到跌倒。这组受试者具有文献中报道的与一类能很好补偿衰老现象的人相对应的特征。第二组功能能力中等（20%为跌倒者）。运动模式似乎不太成功，表现出僵硬姿势的倾向。第三组（100%为跌倒者）功能能力较差。在这组中，运动模式似乎被打乱。受试者除了通过刻板的神经运动反应外，无法令人满意地适应各种情况。总之，本研究证明了生理性神经运动衰老与帕金森病之间存在密切的决定关系。前瞻性随访表明，发生的跌倒与神经运动步态模式的变化有关。还确定了从跌倒风险最小到最大的三个步态模式阶段。
