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Background: Mental disorders are among the most common health issues worldwide. Changes in psychomotor behavior can be observed in gross motor skills. Gait is an example of behavior that reflects various levels of nervous system function. In psychiatric conditions, gait disturbances are thought to reflect defective brain function. Patients who suffer from gait disturbances tend to develop balance disorders as well as impaired body posture. Objective: The purpose of this review is to examine current knowledge regarding gait and related physical aspects (balance and posture) in patients suffering from depression, anxiety or schizophrenia, and to formulate recommendations for the diagnosis and treatment of these patients. Data Sources: A cross search was conducted in five databases, using the following keywords: body posture, balance, and gait. Each of these keywords was cross-referenced with specific mental illnesses: schizophrenia, depression and anxiety. Forty-eight suitable articles complying with criteria were chosen. Major Finding: Our review indicates that patients suffering from mental disorders have a unique physical profile that is in keeping with the clinical diagnosis (schizophrenia, depression and anxiety): the physical profile of patients with schizophrenia is characterized by a slow gait and decreased stride length, patients suffering from anxiety disorders are characterized by balance disorders, and those suffering from depression - by a slow gait and slumped posture. Conclusions: We would propose that when seeking to create an evaluation and treatment program for patients with mental illness, specific elements such as balance, gait patterns and posture, should also be taken into consideration
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Citation: Feldman R, Schreiber S, Pick CG and Been E. Gait, Balance and Posture in Major Mental Illnesses:
Depression, Anxiety and Schizophrenia. Austin Med Sci. 2020; 5(1): 1039.
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Open Access
Background: Mental disorders are among the most common health issues
worldwide. Changes in psychomotor behavior can be observed in gross motor
skills. Gait is an example of behavior that reects various levels of nervous
system function. In psychiatric conditions, gait disturbances are thought to
reect defective brain function. Patients who suffer from gait disturbances tend
to develop balance disorders as well as impaired body posture.
Objective: The purpose of this review is to examine current knowledge
regarding gait and related physical aspects (balance and posture) in patients
suffering from depression, anxiety or schizophrenia, and to formulate
recommendations for the diagnosis and treatment of these patients.
Data Sources: A cross search was conducted in ve databases, using the
following keywords: body posture, balance, and gait. Each of these keywords
was cross-referenced with specic mental illnesses: schizophrenia, depression
and anxiety. Forty-eight suitable articles complying with criteria were chosen.
Major Finding: Our review indicates that patients suffering from mental
disorders have a unique physical prole that is in keeping with the clinical
diagnosis (schizophrenia, depression and anxiety): the physical prole of
patients with schizophrenia is characterized by a slow gait and decreased stride
length, patients suffering from anxiety disorders are characterized by balance
disorders, and those suffering from depression - by a slow gait and slumped
Conclusions: We would propose that when seeking to create an evaluation
and treatment program for patients with mental illness, specic elements such
as balance, gait patterns and posture, should also be taken into consideration.
Keywords: Gait; Balance; Depression; Anxiety; Schizophrenia
Mental disorders are considered one of the most common health
issues worldwide. National Alliance on Mental Illness (NAMI)
data reveal that in any given year, one in every ve adults (aged 18
plus) experience a mental illness and one in 25 adults experience a
severe mental illness, that limits him in one or more of his major-
life-activities. Anxiety and mood disorders are more common among
women, while substance abuse is more common among men [1]. Gait
and posture disorders are common among psychiatric patients. e
reasons for these disorders are many, and include the illness itself,
medication, and the psychosocial context [2].
Motor behavior is regulated by emotions and is an integral
indicator of mental illness [3]. Motor manifestations are important
criteria in the diagnostic method (DSM-5, ICD-10) applied in mood
disorders and help to predict the course of the disease [4,5]. Changes
in psychomotor behavior are evident in facial expressions, gestures,
ne motor skills and gross motor skills [4].
Gait is an example of behavior that reects various levels of
nervous system function. In psychiatric conditions gait disturbances
are thought to reect impaired cortical and subcortical function [6].
Special Article – Depression
Gait, Balance and Posture in Major Mental Illnesses:
Depression, Anxiety and Schizophrenia
Feldman R1*, Schreiber S2,3,4, Pick CG1,4,5 and Been
1Department of Anatomy and Anthropology, Sackler
School of Medicine, Tel-Aviv University, Israel
2Department of Psychiatry, Tel Aviv Sourasky Medical
Center, Israel
3Tel-Aviv University Sackler Faculty of Medicine, Israel
4Sagol School of Neuroscience, Tel Aviv University, Israel
5The Dr. Miriam and Sheldon G. Adelson Chair and
Center for the Biology of Addictive Diseases, Tel-Aviv
University, Israel
6Department of Sports Therapy, Faculty of Health
Professions, Ono Academic College, Israel
*Corresponding author: Ron Feldman, Department of
Anatomy and Anthropology, Sackler Faculty of Medicine,
Tel-Aviv University, Tel-Aviv, 69978, Israel
Received: December 17, 2019; Accepted: January 13,
2020; Published: January 20, 2020
In humans, gait develops simultaneously with the development of
higher-level brain structures and functions (prefrontal cortex, basal
ganglia and cerebellum). Since gait reects the integrity of higher-
level brain systems, it is well able to reect psychiatric conditions
[2]. erefore, analysis of an individual’s gait and posture provides a
great deal of information about the capability of the musculoskeletal
system to adjust to physical stressors [7].
Balance is maintained due to the integration of vestibular,
somatosensory and visual inputs in the central nervous system,
and due to the normal functioning of the motor system which
compensates for postural disorders [8]. Dynamic balance control is
adversely impacted by our mood state, most likely due to impaired
integration of visual, vestibular and proprioceptive systems [9,10].
In general, patients with gait disturbances tend to simultaneously
develop balance dysfunction and therefore, both disorders should
be treated concurrently. Moreover, posture and postural control,
two additional important, interrelated physical characteristics, are a
crucial integral component of normal gait.
Gait and posture are inuenced by body embodiment. Recent
studies have demonstrated the relationship between embodiment
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and mental illness [11-15]. Embodiment addresses the interrelation
between mind and body. In psychological terms, embodiment has a
reciprocal causality in both motor- body and cognitive- emotional
dimensions. Emotional states are embodied in physical movement
and emotion recognition plays an important role in social interactions.
e crucial insight aorded by embodiment is that much of perceptual
inference rests on selecting the correct kind of sensory information.
Indeed the main obstacle is knowing how to react properly using
the right way with our senses. A simple observation is that sadness
is reected by attenuated motor activity [12,14,15]. Consequently, a
disorder in any of the above physical characteristics is able to cause
gait disturbance.
Following the increase in the prevalence of mental disorders [1],
today more than ever before, there is a growing need to investigate
and understand their multiple causes and physical characteristics.
is review focuses on a description of the motor characteristics and
functional manifestations of patients who suer from depression,
anxiety and schizophrenia. e results of this review might provide a
basis for the formulation of an evaluation and intervention program
for these patients.
Data sources and search method
We performed a Meta search, on ve databases (Google Scholar,
PubMed, Science Direct, PsycINFO and Cochrane) using the following
keywords: body posture, balance, and gait, cross-referencing each
keyword with specic mental illnesses: schizophrenia, depression
and anxiety. e search was conducted in May 2018 and updated in
December 2018. No limiters were applied to the search (Figure 1).
Inclusion criteria: Interventional studies (clinical trials), cross-
sectional studies, prospective cohort studies, literary reviews and
meta-analysis; Studies researching schizophrenia, anxiety and
depression and to gait/balance/posture; Studies published in English;
Access to full-text; Studies conducted between 1997 and 2017.
Exclusion criteria: Case control or case descriptions; Letters to
the editor; Studies published in languages other than English; No
access to full-text.
Data synthesis and analysis
At the end of each search phase, the titles and abstracts of the
articles were read systematically and screened according to the
inclusion and exclusion criteria described above. Articles that
appeared to be relevant to the review were read in their entirety.
Finally, a search of the reference list of each article was conducted in
an attempt to locate other articles relevant to the review (Figure 1).
Forty eight articles, which satised the inclusion criteria of the
study, were chosen. ese articles examine the association between
mental disorders, mental states and physical characteristics (Figure
Posture and depression: ere is a consensus among researchers
that depression adversely aects posture [7,13,16]. Michalak et
al. [13] recently found that sitting posture has a direct eect on
memory among patients suering from depression, and that a minor
motor change i.e. adopting an upright sitting posture rather than
slump posture while sitting has a benecial impact on that aspect.
Wilkes et al. [16] suggested that sitting upright reduces fatigue and
increases positive aect among people exhibiting symptoms of
depression. Canales et al. [7] studied posture and perceived body
image in patients with clinical depression during depressive episodes
and upon receiving drug treatment, compared to a healthy control
group. ey found that during depressive episodes patients with
major depressive disorder (MDD), experience a change in posture
(e.g., marked head exion, scapular protraction, pelvic retroversion,
greater thoracic kyphosis) and moderate dissatisfaction with body
image. Furthermore, the study had demonstrated that recurrence of
depressive episodes has a negative inuence on postural alignment.
is nding is consistent with the fact that both emotional and
physical aspects are negatively inuenced by depression.
Balance and depression: A number of studies have found balance
disorders and depression to be related [17,18]. Doumas et al. [19]
detected a considerable deciency in dynamic balance in dual task
performance among patients with depression compared to healthy
controls. Recent studies stress the importance of various physical
training programs in the treatment and amelioration of balance
disturbances among patients with depression, and in the alleviation
of symptoms of depression among healthy individuals [17,18].
Deschamps et al. [17] found that a walking program (supervised
Figure 1: Results scheme of the review process.
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one hour sessions, three times a week for two months at moderate
intensity) has a direct inuence on the ability of MDD patients to make
ecient postural corrections. e authors emphasize the importance
of including a balance assessment in the clinical screening routine in
order to tailor a walking program for these patients.
Gait and depression: ere is a strong association between
MDD, psychomotor deterioration and gait components [12,20].
Lemke et al. [20] were the rst to study spatiotemporal gait patterns
among MDD patients compared to healthy controls. ey found a
signicant reduce in gait velocity, reduced stride length, increased
gait cycle duration and longer double limb support among depressed
patients. e researches addressed to a link between the basal
ganglia activity as part of the pathophysiological mechanism in gait
disturbance. Michalak et al. [12] found that sadness and depression
are characterized by reduced walking speed, arm swing and vertical
head movements, and by greater lateral swaying movements of the
upper body and a slumped posture. A link has been established
between symptoms of depression, reduced walking speed and
increased risk of falls among the elderly. Evidence shows that reduce
gait speed is one of the symptoms of depression in older people, and
that it directly contributes to increased fall risk. Early detection and
integrated treatment of these elements could lower this risk [21].
Paleacu et al. [22] found that gait and cognitive function improved
in response to the administration of antidepressants. In depression,
the neuro circuit pathway related to gait alternations is controversial.
While some researches state that gait changes associate with changes
in brain structures e.g. basal ganglia and cognitive dysfunction
[20,22], others do not point a specic underlying organic pathology
In conclusion, patients with depression are characterized by
slumped posture, impaired dynamic balance, and reduced gait
velocity [2,12,13,16,20,23]. eir slumped posture is in all likelihood
caused by impaired perceived body image, while reduced walking
speed is apparently the result of impaired spatiotemporal parameters
[20]. Future study should focus on the inuence of intervention
programs involving treatment for posture and gait on physical and
mental characteristics of these patients.
Posture and anxiety: Very little information regarding posture
and anxiety was found in the literature. Lipnicki and Byrne [24] found
that study subjects asked to perform a dicult mental arithmetic task
in standing position experienced anticipatory anxiety, as opposed
to subjects who were required to perform the same assignment in
supine condition. One of the explanations suggested is the dierence
in baroreceptor load when the body is in supine position. e paucity
of information on the subject suggests an immediate need to examine
whether a relationship exists between anxiety and posture.
Balance and anxiety: Researchers concur that anxiety is related
to balance dysfunction [8,25,26]. Bart et al. [25] found a correlation
between balance, anxiety disorders and low self-esteem in children
under the age of 7. ey also demonstrated that treatment targeting
balance problems mitigates the dysfunction, greatly reduces anxiety
and increases self-esteem among these children.
e neurological basis that links anxiety disorders and balance
control has been researched for many years [26]. It has been found
that neural circuits that contain a number of pathways that mediate
autonomic control, vestibulo-autonomic interactions and anxiety
form the basis for this link. e core of this neural circuitry is the
parabrachial nucleus (PBN), located in the medulla oblongata. is
nucleus has an extensive network of relationships with a number of
important brain structures responsible for movement and balance
control, including the central amygdaloid nucleus, infralimbic
cortex and hypothalamus. e PBN is the point of convergence of
vestibular, visual and sensory information processing in pathways
that are involved in anxiety, panic and avoidance situations. is
neurological scheme creates a basis that explains the link between
balance disorders and anxiety [26].
Yardley et al. [27] presented evidence of three psychological
mechanisms that aggravate dizziness and delay recovery from
balance disorders. e rst mechanism is avoidance of performing
the movements and of exposure to the environments that caused
the symptoms. e second is increased anxiety, which intensies the
physical symptoms that accompany balance disorder, and the third is
cognitive load, which can have an eect on the central processing of
information needed to maintain control and perception of physical
Gait and anxiety: Gait has hardly been studied in anxiety
disorder. It seems that anxiety requires greater attentional demands
while walking. Anxiety inuences oculo-motor and gaze control [28],
thus linking anxiety to visual disturbances and balance disorders.
Researchers agree that gait changes in anxiety disorders are a
secondary component of the illness, not indicating a dierent or
more severe state [28,29].
In conclusion, people who suer from anxiety disorders are
mainly characterized by deciencies in the balance system [25-27].
is decit in balance is related to increased fear of falling and reduced
gait velocity. Future study should perform a more in depth research
regarding the characteristics of gait and posture in patients suering
from anxiety. ere is also a strong need for research that will explore
the inuence of intervention programs on posture, balance and gait
in this population.
Posture and schizophrenia: Referring to body posture, it is
well known that schizophrenic patients suer from alterations in
body perception, body representations and embodiment [11,14,30].
e signicant anity between emotion perception decits in
schizophrenia, suggests that such diculties may be more directly
related to the core features of this disorder [30]. Graham-Schmidt et
al. [11] indicate that body structural description may be altered in
schizophrenia in general, and body image alterations are worsened
in passivity symptoms. Cristiano et al. [31] examined gross – body
postural changes in dierent stages of schizophrenia and their
relationship to pain. ey had found that hyperlordosis and forward
head posture were the most common postural features in both
early and late stages of schizophrenia. ese two postural changes
are indicative of a lordotic or a swayback posture, which is more
common in women. However, as the majority of cases occur in men,
these changes may be attributable to schizophrenia itself as well as to
body mass index (BMI), as overweight tends to lead to a swayback
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posture. Cristiano et al. [31] also found that scoliosis is frequent
amongst schizophrenic patients, characterized by BMI-independent
muscle weakness.
Balance and schizophrenia: ere is a consensus in the literature
that balance in schizophrenia patients is decient compared to
healthy individuals, and that the degree of postural sway increases in
this population. It has been found that there is a correlation between
this increase and the severity of the symptoms of the disease [32-34].
One of the mechanisms suggested as causing balance dysfunction in
schizophrenic patients is the reduced use of vision for balance control
[35]. is nding points to impaired sensorimotor integration in
these patients, where decient vision control is most likely caused
by defective processing of spatial elements of visual information
and may be related to a visual impairment. Schizophrenic patients
rely more on vestibular and proprioceptive information to maintain
balance compared to healthy individuals [35].
Gait and schizophrenia: Much has been written about the
association between gait and schizophrenia. ere is general consensus
among researchers that schizophrenia causes a primary disturbance
in stride length regulation, which is manifested in a reduction in gait
velocity compared to healthy controls [36]. Putzhammer et al. [36]
found that this decit is intensied by conventional antipsychotic
treatment, whereas non-drug treatment does not lead to such
intensication. Moreover, these researchers assessed gait patterns
among schizophrenic patients by testing free gait and walking on
a treadmill at various velocities. When walking freely, gait velocity
of the patient group was found to be lower than that of the control
group, primarily because of reduced stride length. When evaluating
gait on the treadmill, dierences between the patient group and
control group in cadence and stride length were signicant only at
the very slow treadmill speed. When treadmill velocity was increased,
all parameters in the patient group were equal to the corresponding
parameters in the control group. is outcome indicates that gait
disturbances among schizophrenic patients can be normalized by
using external devices, such as a treadmill, which aords control
over gait velocity. An additional option for achieving improvement
in gait parameters among patients with schizophrenia was proposed
by Heggelund et al. [37], who recommend maximal strength training
– four repetitions * four sets – using a leg press machine (1RM – one
rep max at 85%-90%) as a therapeutic tool in normalizing walking
mechanical eciency among patients with schizophrenia.
Schizophrenics also suer from ataxic gait, and a correlation has
been established between increasing age and ataxic gait among these
patients [38,39]. Furthermore, Morgante et al. [40] provide evidence
that older aged chronic schizophrenic patients, might present axial
parkinsonian signs (trunk posture anomaly, reduced degree of facial
expression and short step gait) as an early marker of parkinsonism in
this illness.
Gait function among schizophrenics is in all likelihood aected as
a result of impaired executive function [39]. Lallart et al. [39] examined
the association between executive dysfunction and gait disturbance
in recent-onset schizophrenia patients using the dual task paradigm.
ey established the existence of an inverse relationship between the
complexity and diculty of the task and the performance level, and
concluded that schizophrenia is characterized not only by cognitive
impairment, but by coordination and motor functioning impairment
as well.
ere is a general agreement in the literature, that schizophrenic
patients has primarily alternation in higher-level structures
e.g. reduction in supplementary motor area activity, disturbed
functioning in the basal ganglia and the thalamus and abnormal
functional connectivity between the motor cortex and the cerebellum.
is core illness decit alters motor control and contributes to the
impairments and reduction of gait control [22,28,29,36].
In conclusion, Schizophrenic patients are characterized by
impaired gait, reduced acuity of the body structural description, as
well as deciencies in the balance system. e reduction in walking
speed is most likely due to the fact that this illness involves executive
dysfunction [39] whereas disembodiment and alterations in body
representations contribute to decits in their body posture [11,14].
Poor balance control is apparently linked to defective processing of
spatial elements [32-35].
Future study should explore the inuence of specic exercise
programs on the posture, balance and gait of patients with
is review examined the link between physical characteristics
(gait, posture and balance) and mental illnesses – depression, anxiety
and schizophrenia. is review emphasizes the growing need for the
creation of a diagnostic, treatment and intervention plan, specically
tailored to patients suering from mental illnesses.
e results of this review show that gait, balance and postural
disturbances are highly prevalent among the mentally ill in
comparison to healthy individuals [2,12,39,20-22,28,29,36-38]. In
light of this observation, we propose including tests for balance, gait,
and posture to the evaluation of patients with psychiatric disorders.
More specically, we have shown that patients with depression
suer from slumped posture, poor dynamic balance, and reduced
gait velocity. erefore we suggest that treatment plan for these
patients might include practicing varying walking speeds and
postural elements [12,13,16,20,23]. We propose the inclusion of a
walking program (one hour sessions, three times a week at moderate
intensity) as an integral component of the treatment program to
improve balance in these patients [17].
Patients who suer from anxiety disorders characterized by
deciencies in the balance system. erefore they might benet from
the inclusion of exercise treatment that targets components of the
balance system in their treatment program [25-27].
With regard to schizophrenic patients, evaluation and treatment
programs might address physical aspects such as gait and balance.
As perceptual elements and executive functions are impaired in this
illness [39], these aspects should be taken into consideration when
planning a treatment program. For the treatment of body posture
representation, body-oriented psychological therapy should be
applied together with specic spatial information exercises, referring
to body parts [11,14,15]. Further, work should be done with patients
on the components of balance control, particularly the visual aspect,
which impacts the degree of postural sway [32]. Emphasis should be
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placed on walking speed, since gait disturbances in schizophrenia
patients can be normalized by using external devices, such as a
treadmill [36].
Despite the extensive research on the eectiveness of systematic
physical activity and exercises interventions for people with mental
illness there is lack of information referring the question: does
improvement in gait and balance eect the psychiatric illness, per se,
or does it transiently aect the sense of well- being? [41-45].
A number of methodological limitations can be noted in the
studies examined. Most of the research published to date was
performed on a relatively small sample (n<30) and no randomized
controlled trials were conducted. Part of the studies were cross-
sectional or consisted of reviews of the literature [14,15,17,18,21,26-
28,36], and no follow-ups were made of a single cohort in the long
term [16,24]. A small number of the studies do not take confounding
factors into account, such as age, gender, cigarette smoking, alcohol
consumption, socioeconomic status, general health condition, etc
[19,24,39]. It is important to point out that some of the studies were
carried out under laboratory conditions, thus aecting their external
validity [7,11,12,24,39,46]. Another limitation is the diculty of
controlling and supervising the use of antipsychotics and their
impact on research results [12,19,31,33]. It is important to note
that although postural dysfunctions as well as motor abnormalities
are oen regarded as consequences of antipsychotic treatments
[47], spontaneous involuntary movements have also been found in
antipsychotic naïve patients [48].
is review did not address the importance of devising physical
training or rehabilitation programs and their inclusion as an integral
component of the rehabilitation process of population groups
suering from mental illness. e physical elements were examined
individually and were not integrated in order to test the ecacy of
their inclusion in treatment programs and their importance to this
population. In other words, we did not, for example, explore the
question as to whether a program that integrates balance and gait
components is preferable to a treatment program that focuses on a
single physical aspect.
Finally, additional, broader clinical research should be carried out
on the association between walking and balance aspects and mental
disorders, and the ecacy of exercise treatment plans. ese physical
elements are an important predictor of falls [21,36] and cognitive
impairment, especially in the elderly population [38,39].
In summary, the clinician treating a patient with a particular
mental disorder should take into consideration the physical aspects
that are characteristic of the patient’s mental condition, as part of the
evaluation/treatment program. e correct identication of these
physical components and appropriate treatment can contribute
greatly to improve function and participation in this complex
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... Information regarding PPD can be particularly useful for designing custom orthotics in order to better support specific regions of the foot, which can reduce the risk of falling or developing adverse foot or lower extremity pathologies. Abnormalities in the distribution of plantar pressure or gait has been associated with adverse long-term health effects, such as having an increased slip and fall risk [30,31], diabetes [32], or neurodegenerative diseases [33,34], as well as anxiety and depression [35], and thus can be used as a diagnostic indicator to signal for such physiological or psychological abnormalities [35]. For instance, individuals with hip osteoarthritis tend to exert less pressure on the heel than those without hip osteoarthritis [36]. ...
... Information regarding PPD can be particularly useful for designing custom orthotics in order to better support specific regions of the foot, which can reduce the risk of falling or developing adverse foot or lower extremity pathologies. Abnormalities in the distribution of plantar pressure or gait has been associated with adverse long-term health effects, such as having an increased slip and fall risk [30,31], diabetes [32], or neurodegenerative diseases [33,34], as well as anxiety and depression [35], and thus can be used as a diagnostic indicator to signal for such physiological or psychological abnormalities [35]. For instance, individuals with hip osteoarthritis tend to exert less pressure on the heel than those without hip osteoarthritis [36]. ...
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Wearable health monitoring devices allow for measuring physiological parameters without restricting individuals’ daily activities, providing information that is reflective of an individual’s health and well-being. However, these systems need to be accurate, power-efficient, unobtrusive and simple to use to enable a reliable, convenient, automatic and ubiquitous means of long-term health monitoring. One such system can be embedded in an insole to obtain physiological data from the plantar aspect of the foot that can be analyzed to gain insight into an individual’s health. This manuscript provides a comprehensive review of insole-based sensor systems that measure a variety of parameters useful for overall health monitoring, with a focus on insole-based PPD measurement systems developed in recent years. Existing solutions are reviewed, and several open issues are presented and discussed. The concept of a fully integrated insole-based health monitoring system and considerations for future work are described. By developing a system that is capable of measuring parameters such as PPD, gait characteristics, foot temperature and heart rate, a holistic understanding of an individual’s health and well-being can be obtained without interrupting day-to-day activities. The proposed device can have a multitude of applications, such as for pathology detection, tracking medical conditions and analyzing gait characteristics.
... Prior research indicated a specific pattern of gait impairments in schizophrenia, including disturbed stride length regulation at unchanged cadence, resulting in reduced velocity 19,25,38 . In line with previous studies, we found slower velocity in patients in comparison to healthy controls. ...
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Schizophrenia is a severe mental disorder, in which 50% of the patients present with motor abnormalities such as psychomotor slowing. Slow spontaneous gait has been reported in schizophrenia. However, comprehensive objective instrumental assessments of multiple gait conditions are missing. Finally, the specific gait patterns of subjects with psychomotor slowing are still unknown. Therefore, this study aimed to objectively assess multiple gait parameters at different walking conditions in patients with schizophrenia with and without psychomotor slowing. Also, we hypothesised gait impairments to correlate with expert ratings of hypokinetic movement disorders and negative symptoms. We collected gait data (GAITRite®) in 70 patients with psychomotor slowing (SRRS (Salpetriere retardation rating scale) ≥15), 22 non-psychomotor slowed patients (SRRS < 15), and 42 healthy controls. Participants performed four walking conditions (self-selected speed, maximum speed, head reclined, and eyes closed) and six gait parameters were extracted (velocity, cadence, stride length, functional ambulation profile (FAP), and variance of stride length and time). Patients with psychomotor slowing presented slower velocity, lower cadence, and shorter stride length in all walking conditions compared to healthy controls, with the non-slowed patients in an intermediate position (all F > 16.18, all p < 0.001). Secondly, slower velocity was associated with more severe hypokinetic movement disorders and negative symptoms. In conclusion, gait impairments exist in a spectrum with healthy controls on one end and patients with psychomotor slowing on the other end. Patients with psychomotor slowing are specifically impaired when an adaptation of gait patterns is required, contributing to the deleterious effects of sedentary behaviours.
... We found a significant association between the presence of depression and the effectiveness of rehabilitation. It is well known that patients with depression have posture, balance and walk impairment, including a reduced walk speed, and studies have shown the effectiveness of physical exercise in improving motor skills in depressed patients [31][32][33]. This result is therefore consistent with the literature. ...
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Walk speed measured under dual-task conditions (neurocognitive tasks) could reflect patient performance in real-life. Rehabilitation programs are effective in increasing walk speed, but few studies have evaluated the associations between geriatric factors and rehabilitation efficacy under dual-task conditions. Our objective was to investigate the association between geriatric factors and an increase in dual-task walk speed (threshold of 0.1 m/s), after a multidisciplinary rehabilitation program. We performed a retrospective cohort study that included patients aged 75 years and over, who underwent a complete rehabilitation program and who had a neurocognitive assessment at baseline. The primary outcome was the increase in the dual-task (fluency verbal task) walking speed between pre-and post-rehabilitation assessments. In this study, 145 patients were included, with a mean age of 83.6 years old. After rehabilitation, dual-task walk speed increase in 62 (43%) patients. In multivariate analysis, the following factors were associated with an increase in dual-task walk speed : IADL (OR 2.50, 95% CI [1.26; 4.94], p = 0.009), vitamin D level (OR 0.83, 95% CI [0.72; 0.95], p = 0.008), severe sarcopenia (OR 0.00, 95% CI [0.00; 0.32], p = 0.016), depression (OR 15.85, 95% CI [1.32; 190.40], p = 0.029), number of drugs (OR 1.41, 95% CI [1.04; 1.92], p = 0.027), initial dual-fluency walk speed (OR 0.92, 95% CI [0.86; 0.98], p = 0.014) and time interval between initial and final assessments (OR 0.98, 95% CI [0.96; 1.00], p = 0.06). Identifying patients that are less resilient to rehabilitation may promote a centered-patient approach for an individualized and optimized rehabilitation care.
... It mainly affects the neuropsychological system. People with SSD initially experience disorganized thought, including hallucination, and delusion, and gradually develop deficits in both basic cognitive abilities (such as attention and memory) [18] and higher-order cognitive functions (such as poor executive function and motor planning) [19], motivation to participate in daily activities, and physical capacity (evident as poor motor efficiency and postural instability) [20]. Executive function is a collective term for cognitive flexibility, inhibitory control, and action planning; the lack of executive function is one of the main causes of poor functional perform in people of neurological conditions. ...
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Schizophrenia spectrum disorder (SSD) is a disabling mental illness that causes considerable deficits in motor and cognitive functions. The purpose of this study was to examine the effects of combining traditional multitask training (TMT) and video games--a new form of multitask training (video game multitask training VGMT)--on cognition and motor control performance in people with SSD. This was a quasi-experimental, pretest-posttest design study. A total of 25 patients participated in this study voluntarily (13 males and 12 females, average age = 59.61 years, SD– 11.46 years). All participants underwent two stages of training. The first stage involved TMT, and the second stage involved VGMT. Each training stage was 12 weeks long, with sessions twice a week that lasted for 40 minutes. Cognition, upper extremity motor and postural control performance, and functional mobility and subjective balance confidence were measured at three times: before and after the first-stage training and after the second-stage training. The results revealed that TMT and the combination of TMT and VGMT improved SSD patient’s cognition, upper extremity motor control, functional mobility and postural control performance. The subjective confidence of balance during the performance of daily activities was also mildly improved. Training with multitasks in the form of video games tended to further improve the outcome measures. Patients with SSD could benefit from regular participation in various forms of multitasking activities. Whether video games training are better than TMT in improving the functional ability of people with SSD needs further investigation. Study protocol registration:, ID: NCT04629898 . Registered brief title: Level of Immersion of Virtual Reality and Cognition and Motor Performance in Patients of Schizophrenia Spectrum Disorder.
... These findings are in line with previous literature finding greater variation in inter-limb movement associated with decreased scores on objective [55] and subjective [35] indices of energy. Interestingly, these inter-limb variations and the mismatch between upper-and lower-extremity movement are patterns similar to literature examining the association between anxiety and gait [56,57], a mood associated with feelings of low energy [58]. Previous literature supports the association between arm swing ROM and feelings of energy [31,35]. ...
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The objective of this study was to use machine learning to identify feelings of energy and fatigue using single-task walking gait. Participants (n = 126) were recruited from a university community and completed a single protocol where current feelings of energy and fatigue were measured using the Profile of Moods Survey-Short Form approximately 2 min prior to participants completing a two-minute walk around a 6 m track wearing APDM mobility monitors. Gait parameters for upper and lower extremity, neck, lumbar and trunk movement were collected. Gradient boosting classifiers were the most accurate classifiers for both feelings of energy (74.3%) and fatigue (74.2%) and Random Forest Regressors were the most accurate regressors for both energy (0.005) and fatigue (0.007). ANCOVA analyses of gait parameters comparing individuals who were high or low energy or fatigue suggest that individuals who are low energy have significantly greater errors in walking gait compared to those who are high energy. Individuals who are high fatigue have more symmetrical gait patterns and have trouble turning when compared to their low fatigue counterparts. Furthermore, these findings support the need to assess energy and fatigue as two distinct unipolar moods as the signals used by the algorithms were unique to each mood.
... Consequently, it affects the overload of the locomotor system and low-back pain [9]. In addition, in certain diseases (depression, general anxiety disorder, schizophrenia), where there is a high level of anxiety or stress as well as increased muscles tension, the parameters of postural control may deteriorate [29,30]. Taking into account the above-mentioned reports, it is important to examine whether in young people deliberate change of muscular tension will significantly affect the parameters describing stability. ...
... Gait disturbances are common in the psychiatric population and were recently reported in patients with anxiety [18][19][20][21][22]. These disturbances are thought to reflect impaired cortical and subcortical function [23,24]. ...
Background Psychomotor retardation has long been recognized as a major feature of depression, and anxiety disorders have been linked with freeze and flight motor responses. This review and meta-analysis aimed a) to synthesize available evidence of motor differences in individuals with depression and anxiety disorders compared to healthy individuals and b) to evaluate the effect of experimental manipulations of motor displays within these clinical groups. Method The databases PubMed and PsycINFO were searched for studies either assessing motor differences between clinical and healthy control groups or manipulating the motor system within a clinical group. Results The literature search yielded 87 relevant papers, comprising 82 studies comparing a clinical group to a healthy group and 5 studies investigating motor manipulations within a clinical sample. The results of the meta-analysis (K = 71) indicated a statistically significant combined estimate of differences between healthy and clinical groups (g = 0.38 [0.31, 0.45], adjusted for publication bias g = 0.26 [0.19, 0.33]) of a small size. This effect did not vary according to type of disorder (anxiety vs. depression, p = .468). From a narrative review of experimental studies within clinical groups, four out of five studies reported significant effects of manipulating the motor system on affective outcomes. Discussion This synthesis adds to the accumulating empirical evidence on motor alterations in depression and anxiety disorders. Future research will need to investigate how individuals sufferings from depression or anxiety could benefit from psychological, behavioral, and physical interventions directly aimed at the motor system.
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Motor abnormalities occur in the majority of persons with schizophrenia but are generally neglected in clinical care. Psychiatric diagnostics fail to include quantifiable motor variables and few assessment tools examine full-body movement. We assessed full-body movement during gait of 20 patients and 20 controls with motion capture technology, symptom load (PANSS, BPRS) and Neurological Soft Signs (NSS). In a data-driven analysis, participants' motion patterns were quantified and compared between groups. Resulting movement markers (MM) were correlated with the clinical assessment. We identified 16 quantifiable MM of schizophrenia. While walking, patients and controls display significant differences in movement patterns related to posture, velocity, regularity of gait as well as sway, flexibility and integration of body parts. Specifically, the adjustment of body sides, limbs and movement direction were affected. The MM remain significant when controlling for medication load. They are systematically related to NSS. Results add assessment tools, analysis methods as well as theory-independent MM to the growing body of research on motor abnormalities in schizophrenia.
Currently, depression has become a common mental disorder, especially among postgraduates. It is reported that postgraduate students have a higher risk of depression than the general public, and they are more sensitive to contact with others. Thus, a non-contact and effective method for detecting people at risk of depression becomes an urgent demand. To make the recognition of depression more reliable and convenient, we propose a multi-modal gait analysis-based depression detection method that combines skeleton modality and silhouette modality. Firstly, we propose a skeleton feature set to describe depression and train a Long Short-Term Memory (LSTM) model for sequences strategy. Secondly, we generate Gait Energy Image (GEI) as silhouette features from RGB videos and design two Convolutional Neural Network (CNN) models with a new loss function to extract silhouette features from front and side perspectives. Then, we construct a multi-modal fusion model consisting of fusing silhouettes from the front and side views at the feature level and the classification results of different modalities at the decision level. The proposed multi-modal model achieved accuracy at 85.45% in the dataset consisting of 200 postgraduate students (including 86 depressive ones), 5.17% higher than the best single-mode model. The multi-modal method also shows improved generalization by reducing the gender differences. Furthermore, we design a vivid 3D visualization of the gait skeletons, and our results imply that gait is a potent biometric for depression detection.
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Postural dysfunctions are prevalent in patients with schizophrenia and affect their daily life and ability to work. In addition, sensory functions and sensory integration that are crucial for postural control are also compromised. This study intended to examine how patients with schizophrenia coordinate multiple sensory systems to maintain postural stability in dynamic sensory conditions. Twenty-nine patients with schizophrenia and 32 control subjects were recruited. Postural stability of the participants was examined in six sensory conditions of different level of congruency of multiple sensory information, which was based on combinations of correct, removed, or conflicting sensory inputs from visual, somatosensory, and vestibular systems. The excursion of the center of pressure was measured by posturography. Equilibrium scores were derived to indicate the range of anterior-posterior (AP) postural sway, and sensory ratios were calculated to explore ability to use sensory information to maintain balance. The overall AP postural sway was significantly larger for patients with schizophrenia compared to the controls [patients (69.62±8.99); controls (76.53±7.47); t1,59 = -3.28, p
In recent decades, embodiment has become an influential concept in psychology and cognitive neuroscience. Embodiment denotes the study of the reciprocal (causal) relationships between mind and body, with the mind not only affecting the body but also vice versa. Embodied cognition comes to the fore in sensorimotor coupling, predictive coding, and nonverbal behavior. Additionally, the embodiment of the mind constitutes the basis of social interaction and communication, as evident in research on nonverbal synchrony and mimicry. These theoretical and empirical developments portend a range of implications for schizophrenia research and treatment. Sensorimotor dysfunctions are closely associated with affective and psychotic psychopathology, leading to altered timing in the processing of stimuli and to disordered appraisals of the environment. Problems of social cognition may be newly viewed as disordered embodied communication. The embodiment perspective suggests novel treatment strategies through psychotherapy and body-oriented interventions, and may ultimately provide biomarkers for diagnosis.
Introduction: We have recently demonstrated evidence of nigro-striatal denervation, disease progression and response to levodopa in a subgroup of patients with schizophrenia who developed parkinsonism. Objective: In the present study, we investigated whether axial parkinsonian signs might be an early manifestation of parkinsonism in schizophrenia not necessarily related to chronic administration of antipsychotic drugs (AP) drugs. Methods: From a baseline cohort of 299 schizophrenic patients who did not satisfy the diagnostic criteria for parkinsonism (presence of at least two of the following appendicular signs: bradykinesia, tremor, rigidity), we identified a group of patients who manifested two out of three axial parkinsonian signs (abnormality of trunk posture, hypomimia and short-step gait). Accordingly, we obtained two sub-groups of patients with schizophrenia, with (Schiz-Axial, N = 26), and without parkinsonian axial signs (Schiz-NO-Axial, N = 273). Clinical and demographical variables were compared between groups. The motor section of the Unified Parkinson's disease rating scale (UPDRS) was employed to measure motor disability. Results: Schiz-Axial patients were significantly older (p = 0.007) and had longer disease duration (p = 0.04) compared to Schiz-NO-Axial. The two groups did not differ for variables related to AP treatment. Total UPDRS motor score (p < 0.0001) as well as limb (p < 0.0001) and axial (p < 0.0001) UPDRS sub-scores were increased in Schiz-Axial patients compared to Schiz-NO-Axial. Conclusions: Our findings provide evidence that axial parkinsonian signs might be an early manifestation of parkinsonism in schizophrenia associated to older age and longer disease duration.
The aim of this study was to investigate associations between poor spinal posture and the recurrence of major depressive episodes and severity of symptoms in patients with major depressive disorder (MDD). This was a cross-sectional quantitative study of MDD patients. Outpatients were recruited from consecutive admissions at a mood disorders unit of a tertiary psychiatric hospital. Of 136 MDD patients, 72 (53 women, 19 men; mean age, 42.4 ± 9.1 years) met all the criteria and completed the study. Forty-one patients were classified with a recurrent episode (RE) of MDD and 31 with a single episode (SE). Quantitative assessments of postural deviations were made using photogrammetry, including kyphosis, shoulder protraction, and head inclination. The severity of depressive episodes was assessed using the Hamilton Depression Rating Scale. The diagnosis and classification of patients were performed according to DSM-IV-TR and SCID criteria. Multivariate analysis of variance indicated that the RE group had greater anterior head inclination (35.39; SD: 1.57), greater scapular abduction (1.69; SD: 0.93), and worse thoracic kyphosis (139.38; SD: 1.19) than the SE group (p < 0.001 for all). Multivariate analysis of covariance showed an interaction between the severity of depressive symptoms and the degree of thoracic kyphosis (p = 0.002). Recurrence of depressive episodes is associated with measures of postural misalignment.
Objectives: To assess the relationship between posture and inflammatory response markers (C-reactive protein [CRP] and von Willebrand factor [vWF]) in schizophrenics. Methods: Forty patients with stable schizophrenia were divided into early-stage (<10 years since first episode, n = 15) and late-stage (≥10 years since first episode, n = 25) groups. Both groups were compared to controls (n = 26). All participants underwent postural assessment by biophotogrammetry. Cases alone underwent blood collection. The significance level was set at 5%, and analyses were carried out in SPSS 18.0. Results: In the early-stage group, 15 postural angles were significantly different from their reference ranges, whereas in the late-stage group, only seven angles were significantly different. In comparison with the control group, only six angles were significantly different. There was no difference in inflammation markers between the early- and late-stage groups. However, CRP levels were higher in cases with greater disease severity, and vWF was associated with forward head posture. Pain correlated with five postural angles, and late-stage patients reported more pain than early-stage cases. Conclusions: CRP was associated with disease severity, while vWF and pain were associated with forward head posture, hyperlordosis and scoliosis, suggesting an association between vascular inflammation and pain, with an influence on posture.
Introduction: Individuals with schizophrenia, particularly those with passivity symptoms, often feel that their actions and thoughts are controlled by an external agent. Recent evidence has elucidated the role of body representations in the aetiology of passivity symptoms, yet one representation – body structural description – has not yet been examined. Additionally, body image has rarely been examined outside of bodily illusions (e.g., rubber hand experiments) and external validation is required. Methods: Body structural description was assessed with an in-between task and a matching body parts by location task, and body image with a questionnaire examining body distortion experiences (containing subscales assessing boundary loss, depersonalisation and body size distortions). Individuals with schizophrenia (20 with current, 12 with past and 21 with no history of passivity symptoms) and 48 healthy controls participated in the study. Results: People with schizophrenia (as a group) made more errors on the in-between task, but not on the matching body parts by location task. Individuals with current passivity symptoms reported greater distortions on all subscales relative to the other clinical samples, except for experiences of boundary loss which were common to both passivity symptom groups. Conclusions: The results indicate that body structural description may be altered in schizophrenia generally and body image alterations are worsened in passivity symptoms, and these alterations likely contribute to the emergence of passivity symptoms.
The present work examines how stooped versus straight body postures influences recovery from negative mood. In Experiment 1 (N = 229), participants were assigned to a negative or neutral mood induction condition, after which they were instructed to take either a stooped, straight, or control posture while writing down their thoughts. Stooped posture (compared to straight or control postures) led to less mood recovery in the negative mood condition, and more negative mood in the neutral mood condition. Overall, stooped posture led to more negative thoughts compared to straight or control postures. In Experiment 2 (N = 122), all participants received a negative mood induction, after which half were instructed to engage in cognitive reappraisal and half received no regulation instructions. To assess mood-congruent cognitions, participants were also asked to recall autobiographical memories. Mood recovery was again less successful in a stooped (compared to straight) position, regardless of whether participants engaged in reappraisal. Stooped (versus straight) posture further increased the negativity of autobiographical recall, but not among participants in the reappraisal condition. These findings demonstrate for the first time that posture may play an important role in recovering from negative mood.
Background and objectives: Slumped posture is a diagnostic feature of depression. While research shows upright posture improves self-esteem and mood in healthy samples, little research has investigated this in depressed samples. This study aimed to investigate whether changing posture could reduce negative affect and fatigue in people with mild to moderate depression undergoing a stressful task. Methods: Sixty-one community participants who screened positive for mild to moderate depression were recruited into a study purportedly on the effects of physiotherapy tape on cognitive function. They were randomized to sit with usual posture or upright posture and physiotherapy tape was applied. Participants completed the Trier Social Stress Test speech task. Changes in affect and fatigue were assessed. The words spoken by the participants during their speeches were analysed. Results: At baseline, all participants had significantly more slumped posture than normative data. The postural manipulation significantly improved posture and increased high arousal positive affect and fatigue compared to usual posture. The upright group spoke significantly more words than the usual posture group, used fewer first person singular personal pronouns, but more sadness words. Upright shoulder angle was associated with lower negative affect and lower anxiety across both groups. Limitations: The experiment was only brief and a non-clinical sample was used. Conclusions: This preliminary study suggests that adopting an upright posture may increase positive affect, reduce fatigue, and decrease self-focus in people with mild-to-moderate depression. Future research should investigate postural manipulations over a longer time period and in samples with clinically diagnosed depression. Link to paper
Introduction: Psychomotor slowing is a core feature of depression in late life, but its prognostic value with respect to course and chronicity is unclear. We investigated whether gait speed can predict chronicity of depressive symptoms. Furthermore, we tested whether (1) cognitive slowing and (risk factors for) vascular diseases, (2) a marker of chronic inflammation, and (3) specific somatic conditions could explain this association. Methods: In the population-based Longitudinal Aging Study Amsterdam, 271 aged participants with clinically relevant depressive symptoms (Center for Epidemiologic Studies Depression Scale ≥16) were followed during a period of 6 years. With 14 successive Center for Epidemiologic Studies Depression Scale observations, 3 clinical course types of depressive symptoms were defined. Results: Remission, fluctuating course, and chronic course of depressive symptoms were seen in 21%, 48%, and 30%, respectively. Slowed gait speed at baseline was associated with a chronic course of depressive symptoms using remission as the reference (odds ratio 0.56, 95% confidence interval 0.41-0.77). Processing speed and vascular risk factors explained this association only for 2%. Specific somatic comorbidity (number of chronic diseases, chronic obstructive pulmonary disease, osteoarthritis) or inflammation influenced the odds ratio. Limitation: Some variables were not measured with as much detail as would be possible in a clinical study setting. Conclusions: Slowed gait speed is a robust predictor of chronicity of depressive symptoms in late life, independent of somatic comorbidity and partly in concert with a slowed processing speed. Results suggest that slowed gait speed is an integral part of the depressive syndrome, probably a subtype associated with chronic course, independent of somatic comorbidity.