Investigation of the Relationship Between Plantar Sensation, Postural Balance, Falling Risk and Gait in Patients with Schizophrenia

Year 2019, Volume: 9 Issue: 2, 67 - 73, 01.08.2019

Buket Büyükturan Caner Karartı Alperen Kılıç Öznur Büyükturan

Abstract

Aim: There is no objective data about whether symptom severity
is associated with plantar sensation in schizophrenic individuals. In
addition, the studies examining relationship between symptom severity and postural balance, falling risk, and gait are also inadequate.
Therefore, it was aimed to investigate the relationship between symptom severity and plantar sensation, postural balance, falling risk and
gait in terms of parameters examined.
Material and Method: A total of 45 healthy schizophrenic individuals were included in the study. Individuals who were diagnosed with
schizophrenia by a psychiatrist according to [Diagnostic and Statistical
Manual of Mental Disorders-V] (DSM-V) and clinical assessment were
assessed by an experienced physiotherapist. In the assessment of
the participants, the Positive and Negative Syndrome Scale (PANSS),
Semmes-Weinstein Monofilament (SWM), Berg Balance Scale (BBS),
Tinetti Falls Efficacy Scale (TFES), Walk-a-Line Ataxia Battery (WLAB),
and Timed Up and Go Test (TUG) were used. Pearson Correlation
Analysis was used to evaluate the relationship between symptom severity of the cases and plantar sensory, postural balance, falling risk
and gait.
Results: There was a low-moderate and positive (r=0.35-0.52) correlation between SWM scores and PANSS positive syndrome and
total score subscales (p=0.001-0.025). There was a low-to-moderate
(r = -0.33 / -0.41) and negative relationship between PANSS all subscales and BBS scores (p = 0.011-0.030). It has been found that there
were low-moderate and positive correlations between all subscales
of PANSS and TUG (r=0.33-0.42; p=0.009-0.030) and TFES (r=0.36-
0.41;p=0.011-0.023) scores. Also, there was a significant low-tomoderate and positive correlation between PANSS scores and WLAB
test performed with closed eyes (r= 0.33-0.42; p=0.015-0.043).
Conclusion: The increase in the symptom severity of schizophrenia
is associated with deterioration in plantar sensation, postural balance,
gait and increase in the risk of falling. Secondary problems that may
ocur due to increased symptom severity should be kept in mind by
the clinician. 

Keywords

schizophrenia, plantar sensation, postural balance, falling risk, gait

Şizofrenik Bireylerde Semptom Şiddeti İle Plantar Duyu, Postüral Denge, Düşme Riski ve Yürüme Arasındaki İlişkinin İncelenmesi

Abstract

Amaç: Şizofrenik bireylerde semptom şiddetinin plantar duyuyla ilişkili olup olmadığı ile ilgili objektif bir veriye rastlanılmamıştır. Ayrıca semptom şiddeti ile postüral denge, düşme riski ve yürüme arasındaki ilişkiyi inceleyen çalışmalar da yetersizdir. Bu sebeple, incelenen parametreler açısından semptom şiddeti ile plantar duyu, postüral denge, düşme riski ve yürüme arasındaki ilişkinin incelenmesi amaçlanmıştır. Materyal ve Metot: Bu çalışmaya 45 şizofrenik birey dahil edildi. Psikiyatrist tarafından, [Diagnostic and Statistical Manual of Mental Disorders-V] (DSM-V)’e ve klinik değerlendirmeye göre şizofreni tanısı alan bireyler deneyimli bir fizyoterapist tarafından değerlendirildi. Katılımcıların değerlendirilmesinde Pozitif ve Negatif Sendrom Ölçeği (PANSS), Semmes-Weinstein Monofilamentleri (SWM), Berg Denge Skalası (BDS), Tinetti Düşme Etkinlik Ölçeği (TDEÖ), Walk-aLine Ataxia Battery (WLAB) ve Süreli Kalk Yürü Testi (TUG) kullanıldı. Olguların semptom şiddeti ile plantar duyu, postüral denge, düşme riski ve yürüme arasındaki ilişkinin değerlendirilmesinde Pearson Korelasyon Analizi kullanıldı. Bulgular: Katılımcılarda SWM skorları ile PANSS pozitif sendrom ve toplam skor alt başlıkları arasında düşük orta-orta şiddette (r=0,35- 0,52) pozitif yönde ilişki olduğu saptandı (p=0,001-0,025). PANSS tüm alt skorlar ile BDS skorları arasında düşük orta-orta şiddette (r=-0,33/- 0.41) negatif yönde ilişki bulundu (p=0,011-0,030). PANSS tüm alt skorlar ile TUG (r=0,33-0,42; p=0,009-0,030) ve TDEÖ (r=0,36-0,41; p= 0,011-0,023) skorları arasında da düşük orta-orta şiddette pozitif yönde ilişki bulundu. PANSS skorları ile WLAB testinin gözler kapalı şekilde yapılan test alt başlıkları arasında düşük orta-orta şiddette pozitif yönde istatistiksel olarak anlamlı ilişki bulundu (r= 0,33-0,42; p=0,015-0,043). Sonuç: Şizofrenide semptom şiddetinin artması, plantar duyu, postüral denge ve yürümedeki kötüleşmelerle ve düşme riskindeki artış ile ilişkilidir. Semptom şiddetinin artmasına bağlı olarak meydana gelebilecek sekonder problemlerin, klinisyen tarafından akılda tutulması gerektiği düşünülmektedir

Keywords

şizofreni, plantar duyu, postüral denge, düşme riski, yürüme

References

• 1. Marvel CL, Schwartz BL, Rosse RB. A quantitative measure of postural sway deficits in schizophrenia. Schizophr Res 2004;68(2–3):363–72.
• 2. Bhattacharya A, Morgan R, Shukla R, Ramakrishanan H, Wang L. Non-invasive estimation of afferent inputs for postural stability under low levels of alcohol. Ann Biomed Eng 1987;15:533–50.
• 3. Diener HC, Dichgans J, Guschlbauer B, Bacher M, Langenbach P. Disturbances of motor preparation in basal ganglia and cerebellar disorders. Prog. Brain Res 1989;80:481–8(discussion 479–80).
• 4. Volz H, Gaser C, Sauer H. Supporting evidence for the model of cognitive dysmetria in schizophrenia—a structural magnetic resonance imaging study using deformation-based morphometry. Schizophr. Res 2000;46:45–56.
• 5. Andreasen NC, O’Leary DS, Flaum M, Nopoulos P, Watkins GL, Boles Ponto LL, et al. Hypofrontality in schizophrenia: distributed dysfunctional circuits in neurolepticnaive patients. Lancet 1997;349:1730–34.
• 6. Picard H, Amado I, Mouchet-Mages S, Olie JP, Krebs MO. The role of the cerebellum in schizophrenia: an update of clinical, cognitive, and functional evidences. Schizophr Bull 2008;34(1):155–72.
• 7. Gebhardt S, Hartling F, Hanke M, Mittendorf M, Theisen FM, Wolf-Ostermann K, et al. Prevalence of movement disorders in adolescent patients with schizophrenia and in relationship to predominantly atypical antipsychotic treatment. Eur Child Adolesc Psychiatry 2006;15(7):371–82.
• 8. Le Seach A, Picard H, Gorsane MA, Vidal PP, Amado I, Krebs MO. A step toward an objective quantification of subtle neurological signs in schizophrenia. Psychiatry Res 2012;198(2):230–4.
• 9. Ho BC, Mola C, Andreasen NC. Cerebellar dysfunction in neuroleptic naive schizophrenia patients: clinical, cognitive, and neuroanatomic correlates of cerebellar neurologic signs. Biol Psychiatry 2004;55(12):1146–53.
• 10. Nasrallah HA. Neurologic comorbidities in schizophrenia. J Clin Psychiatry 2005;66 Suppl 6:34–46.
• 11. Varambally S, Venkatasubramanian G, Thirthalli J, Janakiramaiah N, Gangadhar BN. Cerebellar and other neurological soft signs in antipsychotic-naive schizophrenia. Acta Psychiatr Scand 2006;114(5):352–6.
• 12. Matsuura Y, Fujino H, Hashimoto R, Yasuda Y, Yamamori H, Ohi K, et al. Standing postural instability in patients with schizophrenia: Relationships with psychiatric symptoms, anxiety, and the use of neuroleptic medications. Gait Posture 2015;41(3):847–51.
• 13. Leutwyler H, Hubbard E, Cooper BA, Dowling G. Impact of a Pilot Videogame-Based Physical Activity Program on Walking Speed in Adults with Schizophrenia. Community Ment Health J 2018;54(6):735–9.
• 14. Toosizadeh N, Mohler J, Armstrong DG, Talal TK, Najafi B. The influence of diabetic peripheral neuropathy on local postural muscle and central sensory feedback balance control. PLoS ON 2015;10(8): e0135255.
• 15. Kito K, Suzuki K. Research on the Effect of the Foot Bath and Foot Massage on Residual Schizophrenia Patients. Arch Psychiatr Nurs 2016;30(3):375–81.
• 16. Aboraya A. Scientific Forum on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V)-An Invitation. Psychiatry (Edgmont) 2010;7(11):32–6.
• 17. Banwell HA, Mackintosh S, Thewlis D. Foot orthoses for adults with flexible pes planus: a systematic review. J Foot Ankle Res 2014;7(1):23.
• 18. Sung PS. Kinematic analysis of ankle stiffness in subjects with and without flatfoot. Foot (Edinb)2016;26:58–63.
• 19. Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR. What does the PANSS mean? Schizophr Res 2005;79(2–3):231–8.
• 20. Kay SR, Fiszbein A, Opler LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr. Bull 1987;13:261–75.
• 21. Berquin AD, Lijesevic V, Blond S, Plaghki L. An adaptive procedure for routine measurement of light-touch sensitivity threshold. Muscle Nerve 2010;42:328–38.
• 22. Valk GD, de Sonnaville JJ, van Houtum WH, Heine RJ, van Eijk JT, Bouter LM, et al. The assessment of diabetic polyneuropathy in daily clinical practice: reproducibility and validity of Semmes Weinstein monofilaments examination and clinical neurological examination. Muscle Nerve 1997;20:116–8.
• 23. Bell-Krotoski JA, Fess EE, Figarola JH, Hiltz D. Threshold detection and Semmes-Weinstein monofilaments. J Hand Ther 1995;8:155–162.
• 24. Lee S, Kim H, Choi S, Park Y, Kim Y, Cho B. Clinical usefulness of the two-site Semmes-Weinstein monofilament test for detecting diabetic peripheral neuropathy. J Korean Med Sci 2003;18(1):103–7.
• 25. Katon JG, Reiber GE, Nelson KM. Peripheral neuropathy defined by monofilament insensitivity and diabetes status: NHANES 1994–2004. Diabetes Care 2013;36(6):1604–6.
• 26. Berg K, Wood-Dauphinee S, Williams JI, Maki B. Measuring balance in the elderly: validation of an instrument. Canadian Journal of Public Health 1992;83:7–11.
• 27. Tisher K, Mann K, VanDyke S, Johansson C, Vallabhajosula S. Functional measures show improvements after a home exercise program following supervised balance training in older adults with elevated fall risk. Physiother Theory Pract 2018;5:1–13.
• 28. Çinarli T, Koç Z. Fear and risk of falling, activities of daily living, and quality of life: assessment when older adults receive emergency department care. Nurs Res 2017;66(4):330–5.
• 29. Fein G, Smith S, Greenstein D. Gait and balance in treatmentnaïve active alcoholics with and without a lifetime drug codependence. Alcohol Clin Exp Re 2012;36(9):1550–62.
• 30. Choi HS, Shin WS, Bang DH, Choi SJ. Effects of Game-Based Constraint-Induced Movement Therapy on Balance in Patients with Stroke: A Single-Blind Randomized Controlled Trial. Am J Phys Med Rehabil 2017;96(3):184–190.
• 31. Iatridou G, Pelidou HS, Varvarousis D, Stergiou A, Beris A, Givissis P, et al. The effectiveness of hydrokinesiotherapy on postural balance of hemiplegic patients after stroke: a systematic review and meta-analysis. Clin Rehabil 2017;1:269215517748454.
• 32. Flansbjer UB, Holmback AM, Downham D, Patten C, Lexell J. Reliability of gait performance tests in men and women with hemiparesis after stroke. J Rehabil Med 2005;37:75–82.
• 33. Yoshino Y, Yoshida T, Mori T, Hirota S, Iga J, Ueno S. Risk of idiopathic normal pressure hydrocephalus in older inpatients with schizophrenia. Int Psychogeriatr 2016;28(5):863–8.
• 34. Kinney DK, Yurgelun-Todd DA, Woods BT. Neurologic signs of cerebellar and cortical sensory dysfunction in schizophrenics and their relatives. Schizophr Res 1999;35:99–104.
• 35. Teng YL, Chen CL, Lou SZ, Wang WT, Wu JY, Ma HI, et al. Postural Stability of Patients with Schizophrenia during Challenging Sensory Conditions: Implication of Sensory Integration for Postural Control. PLoS One 2016;11(6): e0158219.
• 36. Koreki A, Tsunoda K, Suzuki T, Hirano J, Watanabe K, Kashima H, et al. Clinical and demographic characteristics associated with postural instability in patients with schizophrenia. J Clin Psychopharmacol 2011;31(1):16–21.
• 37. Kaltsatou A, Kouidi E, Fountoulakis K, Sipka C, Theochari V, Kandylis D, et al. Effects of exercise training with traditional dancing on functional capacity and quality of life in patients with schizophrenia: a randomized controlled study. Clin Rehabil 2015;29(9):882–91.
• 38. Hayran M, Hayran M. Sağlık Araştırmaları için Temel İstatistik. Art Ofset Matbaacılık Yayıncılık Organizasyon; Ltd.;Ankara; 2011.
• 39. Scheewe T, Jörg F, Takken T, Deenik J, Vancampfort D, Backx F, Cahn W. Low physical activity and cardiorespiratory fitness in people with schizophrenia: a comparison with matched healthy controls and associations with mental and physical health. Frontiers in psychiatry 2019;10:87.