gms | German Medical Science

Locomotor disorders are the common pathogenetic pathway of the age-related decline and many age-related diseases. Quantifying measures of locomotion is therefore an indispensable part of a medical examination. The locomotor assessment is an effective tool for identifying people at high risk of falling. Deficits of locomotion are also a marker of frailty. Frailty can be defined as a status of reduced physiological reserve, the precursor of disability, a status of high risk of adverse age-related conditions like high comorbidity, mortality, hospitalization and disability. Early stages of frailty have been proven as ideal period for preventive interventions.

Until now there is no consensus which test procedures should be included in a locomotor assessment. It makes sense to choose parameters which have been proven predictive for both falls and impending disability. An appropriate test battery should therefore comprise:

1.

self-selected gait velocity as the single best measure of general locomotor status,

2.

timed 5 chair rises for measuring power of the hip surrounding muscle function as the most important neuromuscular risk factor for falls and fall-related fractures,

3.

Tandem standing and tandem walking for measuring postural capacity (balance) to the side.

Mechanography (Leonardo force plate system, Novotec Pforzheim, Germany) is a new approach to measure movement according to physics. It records the time course of ground reaction forces, velocity of the vertical movements of the center of mass and power during unrestricted physiological movements. In the mechanogram the eccentric and concentric phases of movements can be differentiated and the storage of energy in the elastic elements of the body can be examined. By mechanography power output during unrestricted normal movements can be measured. Power is more correlated to everyday function as force. An objective locomotor assessment is the basis for evaluating new treatment approaches like the vibration therapy. The whole body vibration therapy (Galileo system) stimulates the muscles in a physiologic, reciprocally side-alternating pattern, using spinal reflexes. It has been proven effective in improving power, balance and preventing bone loss during bed rest studies.