Donma Fenomeni Olan ve Olmayan Parkinson Hastalarında Vücut İmajının Denge ve Yürüyüş Üzerine Etkisinin İncelenmesi
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USTA, A. Investigation of the Effect of Body Image on Balance and Gait in Parkinson's Patients with and without Freezing Phenomenon, Hacettepe University Graduate School of Health Sciences, Neurologic Physiotherapy Program, Doctor of Philosophy Thesis, Ankara,2021. 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 (TUG), 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 observed that group I and group II were different from group III in terms of all variables evaluated except for the somatosensory sensory score, preference score and GaitRite data obtained from CDP. BAQ, SPV, SPV left 30 and SHV values of group I and group II were found to be different from each other (p<0.017). Group I was also found to be different from group II in terms of FRT value (p<0.017). When the gait variables and 10MYT results were examined, it was determined that there was no difference between group I and group II (p<0.017). It was determined that there was a relationship between, between TUG and BAQ and knee proprioception in group I; between TST and trunk proprioception and SVV; between the composite balance score and SPV right 30 and trunk proprioception; It was determined that there was a relationship between FUT and SHV left 45 and trunk proprioception. In Group II it was found that there is a relationship between 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, the relationship of ankle proprioception with all temporal parameters of gait except stride duration was found. In addition, SPV 0 was associated with gait cycle and cadence, and BAQ with right and left swaying, stance phases and gait speed (p<0.05). When the distance characteristics of gait were examined, it was determined that 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 correlation between knee proprioception and right-left double stride length (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.