Postural stability, gait, and plantar pressure alterations in schizophrenia patients

Öz

Purpose: Functional and biomechanical alterations have not been clarified yet although motor retardation, coordination and balance impairment are prevalent in schizophrenia patients. The aim of this study was to investigate the differences of postural stability, temporal-spatial gait parameters, dynamic plantar load distribution and functional performance, between schizophrenia patients and healthy controls.

Methods: Twenty-four schizophrenia patients and twenty-three healthy controls participated in this study. Functional performance was assessed by measuring 6-min walking distance. Functional performance was assessed by measuring 6-min walk distance. Biodex Balance System was used to postural stability and dynamic pedobarographic analysis was conducted using a pressure platform.

Results: Six minute walking distance was significantly lower in schizophrenia group than control group (p<0.001). Overall, anteroposterior and mediolateral stability score in static, dynamic and single leg on right and left foot conditions were higher in schizophrenia group (p<0.001). Time spent in quadrant IV (right anterior quadrant) in static condition and time spent in quadrant I (right posterior quadrant) in dynamic condition were less in schizophrenia group (p<0.05). Maximum plantar pressure in forefoot of both feet and in heel of non-dominant foot were less in schizophrenia group (p<0.05).

Conclusion: Our results revealed that functional performance was reduced, postural stability was impaired, and dynamic plantar pressure was altered in schizophrenia patients however temporal-spatial gait parameters were similar with healthy adults. These results may help to understand the underlying mechanisms of motor deteriorations, coordination and balance problems in schizophrenia patients.

Anahtar Kelimeler

• Gait
• Functional Performance
• Postural stability
• Schizophrenia

Şizofreni hastalarında postural stabilite, yürüyüş ve plantar basınç değişiklikleri

Öz

Amaç: Şizofreni hastalarında motor gerilik, koordinasyon ve denge bozukluğu yaygın olmasına rağmen, fonksiyonel ve biyomekanik değişiklikler henüz açıklığa kavuşturulmamıştır. Bu çalışmanın amacı, şizofreni hastaları ile sağlıklı kontroller arasındaki postural stabilite, yürüyüşün zaman-mesafe parametreleri ve dinamik plantar yük dağılımı ve fonksiyonel performans farklılıklarını araştırmaktı.

Yöntem: Çalışmaya 24 şizofreni hastası ve 23 sağlıklı kontrol katıldı. Fonksiyonel performans 6 dakika yürüme mesafesi ölçülerek değerlendirildi. Postural stabiliteyi değerlendirmek için Biodex Denge Sistemi kullanıldı ve dinamik pedobarografik analiz basınç platformu kullanılarak yapıldı.

Bulgular: Şizofreni grubunda 6 dakika yürüme mesafesi kontrol grubuna göre anlamlı olarak daha düşüktü (p<0.001). Statik, dinamik, sağ ve sol tek ayak üzerindeki durumlarda genel, anteroposterior ve mediolateral stabilite skoru şizofreni grubunda daha yüksekti (p<0.001). Statik durumda IV. oktantta (sağ ön oktant) harcanan süre ve dinamik durumda I. oktantta (sağ arka oktant) harcanan süre şizofreni grubunda daha azdı (p<0.05). Her iki ön ayak ve dominant topuktaki maksimum plantar basınç şizofreni grubunda daha düşüktü (p<0.05).

Sonuç: Bulgularımız, şizofreni hastalarında, fonksiyonel performansın azaldığını, postural stabilitenin bozulduğunu ve dinamik plantar basınçlarda değişimler olduğunu, ancak yürüyüşün zaman-mesafe parametrelerinin sağlıklı yetişkinlerle benzer olduğunu ortaya koydu. Bu sonuçlar, şizofreni hastalarındaki motor bozuklukların, koordinasyon ve denge problemlerinin altında yatan mekanizmaların anlaşılmasına yardımcı olabilir.

Anahtar Kelimeler

• Yürüyüş
• Fonksiyonel Performans
• Postural Stabilite
• Şizofreni

Kaynakça

1. 1. Sanders RD, Gillig PM. Gait and its assessment in psychiatry. Psychiatry (Edgmont). 2010;7:38-43.
2. 2. Tsuji Y, Akezaki Y, Mori K, et al. Factors inducing falling in schizophrenia patients. J Phys Ther Sci. 2017;29:448-451.
3. 3. Walther S, Strik W. Motor symptoms and schizophrenia. Neuropsychobiology. 2012;66:77-92.
4. 4. Morrens M, Hulstij, W, Sabbe B. Psychomotor slowing in schizophrenia. Schizophr Bull. 2006;33:1038-1053.
5. 5. Kent JS, Hong SL, Bolbecker AR, et al. Motor deficits in schizophrenia quantified by nonlinear analysis of postural sway. PLoS One. 2012;7:1-10.
6. 6. Dean DJ, Kent JS, Bernard JA, et al. Increased postural sway predicts negative symptom progression in youth at ultrahigh risk for psychosis. Schizophr Res. 2015;162:86-89.
7. 7. Teng YL, Chen CL, Lou SZ, et al. Postural stability of patients with schizophrenia during challenging sensory conditions: Implication of sensory integration for postural control. PloS One. 2016;11:1-16.
8. 8. Lallart E, Jouvent R, Herrmann FR, et al. Gait and motor imagery of gait in early schizophrenia. Psychiatry Res. 2012;198:366-370.

9. 9. Putzhammer A, Heindl B, Broll K, et al. Spatial and temporal parameters of gait disturbances in schizophrenic patients. Schizophr Res. 2004;69:159-166.
10. 10. Crews CK, Vu KO, Davidson AJ, et al. Podiatric problems are associated with worse health status in persons with severe mental illness. Gen Hosp Psychiatry. 2004;26:226-232.
11. 11. Burns J, Crosbie J, Hunt A, et al. The effect of pes cavus on foot pain and plantar pressure. Clin Biomech. 2005;20:877-882.
12. 12. Ledoux WR, Hillstrom HJ. The distributed plantar vertical force of neutrally aligned and pes planus feet. Gait Posture. 2002;15:1-9.
13. 13. Martínez-Nova A, Sánchez-Rodríguez R, Pérez-Soriano P, et al. Plantar pressures determinants in mild Hallux Valgus. Gait Posture. 2010;32:425-427.
14. 14. Chen C, Hong PW, Chen C, et al. Ground reaction force patterns in stroke patients with various degrees of motor recovery determined by plantar dynamic analysis. Chang Gung Med J. 2007;30:62-72.
15. 15. Hessert MJ, Vyas M, Leach J, et al. Foot pressure distribution during walking in young and old adults. BMC Geriatr. 2005;5:1-8.
16. 16. Kimmeskamp S, Hennig EM. Heel to toe motion characteristics in Parkinson patients during free walking. Clin Biomech. 2001;16:806-812.
17. 17. Schmitz R, Arnold B. Intertester and intratester reliability of a dynamic balance protocol using the Biodex Stability System. J Sport Rehabil. 1998;7:95-101.
18. 18. American Thoracic Society. ATS statement: guidelines for the six minute walk test. Am J Respir Crit Care Med. 2002;166:111-117.
19. 19. Chetta A, Zanini A, Pisi G, et al. Reference values for the 6-min walk test in healthy subjects 20–50 years old. Respir Med. 2006;100:1573-1578.
20. 20. Enright PL, Sherrill DL. Reference equations for the six-minute walk in healthy adults. Am J Respir Crit Care Med. 1998;158:1384-1387.
21. 21. Vancampfort D, Probst M, Sweers K et al. Reliability, minimal detectable changes, practice effects and correlates of the 6-min walk test in patients with schizophrenia. Psychiatry Res. 2011;187:62-67.
22. 22. Vancampfort D, Probst M, Scheewe T, et al. Lack of physical activity during leisure time contributes to an impaired health related quality of life in patients with schizophrenia. Schizophr Res. 2011;129:122-127.
23. 23. Vancampfort D, Probst M, Sweers K, et al. Relationships between obesity, functional exercise capacity, physical activity participation and physical self‐perception in people with schizophrenia. Acta Psychiatr Scand. 2011;123:423-430.
24. 24. Vancampfort D, Probst M, De Herdt, et al. An impaired health related muscular fitness contributes to a reduced walking capacity in patients with schizophrenia: a cross-sectional study. BMC Psychiatry. 2013;13:1-8.
25. 25. Bernard P, Romain AJ, Vancampfort D, et al. Six minutes walk test for individuals with schizophrenia. Disabil Rehabil. 2015;37:921-927.
26. 26. Valenti O, Cifelli P, Gill KM, et al. Antipsychotic drugs rapidly induce dopamine neuron depolarization block in a developmental rat model of schizophrenia. J Neurosci. 2011;31:12330-12338.
27. 27. Hall CD, Echt KV, Wolf SL, et al. Cognitive and motor mechanisms underlying older adults' ability to divide attention while walking. Phys Ther. 2011;91:1039-1050.
28. 28. Obeso I, Wilkinson L, Casabona E, et al. Deficits in inhibitory control and conflict resolution on cognitive and motor tasks in Parkinson’s disease. Exp Brain Res. 2011;212:371-384.
29. 29. Rosano C, Studenski SA, Aizenstein HJ, et al. Slower gait, slower information processing and smaller prefrontal area in older adults. Age Ageing. 2011;41:58-64.
30. 30. Scott G, Menz HB, Newcombe L. Age-related differences in foot structure and function. Gait Posture. 2007;26:68-75.
31. 31. Bernard JA, Mittal VA. Cerebellar-motor dysfunction in schizophrenia and psychosis-risk: the importance of regional cerebellar analysis approaches. Front Psychiatry. 2014;5:1-14.
32. 32. Marvel CL, Schwartz BL, Rosse RB. A quantitative measure of postural sway deficits in schizophrenia. Schizophr Res. 2004;68:363-372.
33. 33. Wilczyński J, Pedrycz A, Mucha D, et al. Body posture, postural stability, and metabolic age in patients with Parkinson’s disease. Biomed Res Int. 2017;1-9.