Gangstorung als reduzierte sozial-praktische Kompetenz im Alter - Quantitative und Videofilm-gestutzte Erfassung als Grundlage geriatrischer Rehabilitation

Reduced mobility due to disturbances of gait and balance is one of the most important physiologic threats for 'quality of life' in old age and for successful geriatric rehabilitation. Epidemiologically, 'abnormal gait' in old age is the major risk factor for multiple falls with their deleterious medical and social consequences. In the present investigation, nosologically unexplained gait disorders in old people (N = 81; mean age 82,5 years; 26 healthy controls; mean age 79,3 years) were studied clinically, for stride parameters, and for 'indices of mobility'. The latter were a 'Gait Rating Score' (Videofilm-assisted; GRS) and a 'Balance-Test' (BAT) to assess different aspects of locomotor synergies and dynamic balance during simple and complicated gait and balance tasks. Results: Patients with a history of falls differ in their gait patterns both quantitatively (reduced stride lengths) and qualitatively ('difficulties on turning'). In old people with gait complaints, the GRS clearly illustrates the impaired locomotor synergies that are mirrored by reduced stride parameters. GRS assesses gait predominantly in its locomotor synergy, while BAT reflects both this synergy and that of dynamic equilibrium during gait. Gait impairment in old age is not an exclusive disturbance of either reduced step sequence or defective postural control. Movement training in geriatric rehabilitation should incorporate both aspects of reduced locomotion on the cognitive as well as on the physical level.