Investigation of the effect of body image on balance and gait in parkinsonian patients with and without freezing phenomena

This study was conducted to examine the effect of body image on balance and gait in Parkinson's patients with and without freezing phenomenon. For this purpose, according to the Modified Hoehn & Yahr staging scale, 17 freezer (Group I), 15 non-freezer Parkinson's patients (Group II) and 15 healthy individuals (Group III) who were similar in age and gender, were included in the Parkinson's patient groups. Body image perception was evaluated by examining Subjective Visual Vertical (SVV), Subjective Postural Vertical (SPV), Subjective Haptic Vertical (SHV) tests, Body Awareness Questionnaire (BAQ), and proprioception sense (neck, trunk, knee, ankle proprioception). For the evaluation of balance, tandem stance test (TST), Timed Get Up and Go Test [1], Functional Reach Test (FRT) and Computed Dynamic Posturography (CDP) were used. Gait was evaluated with the 10 M Walk Test (10MWT) and GaitRite. As a result of the study, it was seen that the whole body image variables of group I and group II were different from group III. BAQ, SPV, SPV left 300 and SHV values of group I and group II were found to be different from each other (p<0.017). It was found that the patient groups were different from group III in terms of all balance variables, while group I and group II differed only in terms of FRT value (p<0.017). When the gait variables were examined, it was determined that groups I and II were different from group III in terms of distance characteristics and time characteristics other than right step time (p<0.05). When group I and group II were compared, it was seen that there was no difference between the groups in terms of distance characteristics, but only the right gait cycle time in terms of time characteristics. Similarly, when the 10MWT results were examined, it was seen that there was a difference between the healthy controls and the patient groups, and there was no difference when the patient groups were compared among themselves (p<0.017). When the relationship between balance and body image parameters was examined, there was a relationship, between TUG and BAQ and knee proprioception in group I; between TST and trunk proprioception and SVV; between the combined balance score and SPV right 300 and trunk proprioception; between FUT and SHV left 450 and trunk proprioception. In Group II there was a relationship between trunk proprioception with TST; SPV right 300 with combined balance score; FUT and SHV 45; TUG and SPV. When the relationship between the time characteristics of gait and body image perception was examined, no relationship was found in group II. Whereas in group I, there was a relationship between temporal parameters of gait, except step time and ankle proprioception. In addition, it was found that SPV 00 was associated with gait cycle and cadence, and BAQ associated with right and left sway phase, stance phases and gait speed (p<0.05). When the distance characteristics of gait were examined, BAQ was associated with all distance parameters, and knee proprioception was associated with right and left stride length and double stride length in group I (p<0.005). In Group II, there was only a relationship between knee proprioception and right-left double stride length (p<0.05). According to the correlation analysis of Parkinson's patients without grouping, BAQ and FRT; Other balance variables except SVV and TUG, somatosensory and visual preference scores; With SPV's TST, TUG, combined balance score and vestibular sense score; With SHV's preference score; neck and trunk proprioception were found to be associated with TST, FRT, and combined balance score (p<0.05). While it was found that there was no difference in the distance characteristics of gait, it was determined that the temporal characteristics of stride duration and gait cycle time were correlated with SVV and SPV (p<0.05). As a result, the SVV deviation values were found to be similar in group I and group II, but the SHV and SPV deviation values were different, suggesting that the freezing phenomenon is caused by a disorder in the integration of vestibular and proprioceptive senses rather than a disorder in the integration of vestibular and visual senses. However, the fact that proprioceptive sensory evaluations were similar between group I and group II supports that freezing is not caused by proprioceptive sensory impairment in isolation, but by a disorder in its integration with vestibular sense. It should also be noted that while trunk proprioception and SVV had a differential effect on balance in the group with freezing phenomenon, ankle proprioception, SPV and BAQ were effective in parameters related to walking speed, while knee proprioception and BAQ were effective in parameters related to distance characteristics. Our study supports that training on proprioceptive and vestibular multisensory integration and body image perception in patients with freezing phenomenon will yield beneficial results on balance and gait. Key Words: Parkinson's Disease; Freezing of Gait, Freezing Phenomenon, Body image, Verticality, Balance, Gait