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Background and purpose Skill acquisition (ie, performance changes during practice) occurs in a nonlinear fashion. Despite this, motor learning is typically measured by comparing discrete timepoints. Thus, typical measures of motor learning do not detect skill acquisition characteristics that may be clinically meaningful. Reliable prediction of motor skill learning in people with Parkinson disease (PD) would allow therapists to more effectively individualize practice doses to fit specific patients' needs. The purposes of this study were to (a) characterize postural skill acquisition in people with PD, and identify factors (such as acquisition rate and practice dose to plateau) that predict learning, and (b) investigate whether levodopa medication (L-dopa) status during practice impacted learning. Methods Twenty-seven adults with PD practiced a postural motor task over 3 days, followed by 2 retention tests. Participants were randomized to practice either ON or OFF L-dopa. Data for repeating and random sequences were each analyzed using nonlinear curve-fitting and mixed-effects regressions. Learning was defined as pretest minus retention test performance. Results Participants with less physical impairment demonstrated less learning on the repeating and random sequence tasks compared with participants with more impairment. Participants who improved faster during practice demonstrated less learning on the repeating sequence task compared with participants who improved more slowly. Reaching plateau during practice was not related to learning. L-dopa did not impair learning. Discussion and conclusions Participants' skill acquisition characteristics were related to learning a postural motor task. Patient-specific factors, such as the rate of skill acquisition, level of physical function, and medication status, may influence how postural motor practice is delivered during balance rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A250).

BACKGROUND AND PURPOSE: Impaired gait, balance, and motor function are common in Parkinson disease (PD) and may lead to falls and injuries. Different forms of exercise improve motor function in PD, but determining which form of exercise is most effective requires a direct comparison of various approaches. In this prospective, controlled trial, we evaluated the impact of tango, treadmill walking, and stretching on gait, balance, motor function, and quality of life. We hypothesized tango and treadmill would improve forward walking and motor severity, and tango also would improve backward walking, balance, and quality of life. METHODS: Ninety-six participants (age: 67.2±8.9 years, 42% female) with mild to moderate idiopathic PD were serially assigned to tango, treadmill walking, or stretching (active control group) and attended one-hour classes twice weekly for 12 weeks. Assessments occurred off anti-PD medication before and after the intervention and at follow-up 12 weeks after the intervention. RESULTS: Forward velocity and backward velocity improved for the treadmill group from baseline to post-test and improvements persisted at follow-up. Backward velocity and motor functioning improved for the stretching group from baseline to post-test but results did not persist at follow-up. There were no significant changes in the tango group across time points. DISCUSSION AND CONCLUSIONS: Contrary to our hypotheses, only treadmill improved forward walking, while backward walking improved with treadmill and stretching. Future research should examine combinations of exercises with a focus on optimizing dosing and examining whether specific characteristics of people with PD correlate with different types of exercise. VIDEO ABSTRACT AVAILABLE: for more insights from the authors (see Video, Supplemental Digital Content 1)

Background and Purpose: Relatively little is known about the natural evolution of physical activity–related participation restrictions associated with Parkinson’s disease (PD). We examined this issue prospectively, using continuous monitoring technology to capture the free-living ambulatory activity of persons with PD engaging in life situations. We specifically sought (1) to explore natural, long-term changes in daily ambulatory activity and (2) to compare the responsiveness of ambulatory activity parameters to clinical measures of gait and disease severity. Methods: Thirty-three persons with PD participated (Hoehn and Yahr range of 1–3). Participants wore a step activity monitor for up to 7 days at baseline and again at 1-year follow-up. Mean daily values were calculated for parameters indicative of amount, intensity, frequency, and duration of ambulatory activity. Clinical measures included the Unified Parkinson Disease Rating Scale, the 6-Minute Walk, and Maximal Gait Speed. Parametric tests for paired samples were used to investigate changes in ambulatory activity parameters and clinical measures. Results: Participants had significant declines in the amount and intensity of daily ambulatory activity but not in its frequency and duration (P < 0.007). Declines occurred in the absence of changes in clinical measures of gait or disease severity. The greatest 1-year decline occurred in the number of daily minutes participants spent engaging in at least moderate-intensity ambulatory activity. Conclusion: Continuous monitoring of ambulatory activity beyond mere step counts may serve as a distinct and important means of quantifying declining ambulatory behavior associated with disease progression or improved ambulatory behavior resulting from rehabilitation and medical and/or surgical interventions in persons with PD.

Background and Purpose: Parkinson's disease is a progressive neurodegenerative disorder that affects neurophysiologic function, movement abilities, and quality of life (QOL). Research examining the effects of exercise has suggested benefits related to a variety of outcomes; however, no reviews have synthesized research findings across the spectrum of disability. This project sought to systematically review studies that examined the impact of exercise interventions on balance outcomes for people with Parkinson's disease, within the categories defined by the World Health Organization in the International Classification of Functioning, Disability, and Health (ICF) model. Methods: A systematic review of medical literature databases was performed using keywords Parkinson's disease and exercise. Studies were eligible if the intervention included exercise and examined variables within one of the three ICF categories. Following the ICF model, outcomes regarding Body Structure and Function, Activity, and Participation were measured, respectively, in terms of postural instability, balance task performance, and QOL and fall events. Results: Within the Body Structure and Function category, there was moderate evidence that exercise resulted in improvements in postural instability. Within the Activity category, there was moderate evidence that exercise was effective for improving balance task performance. In contrast, within the Participation category, there was limited evidence that exercise resulted in improvements in QOL measures or fall events. Discussion and Conclusions: Regardless of the strength of the evidence, the studies reviewed all report that exercise resulted in improvements in postural stability and balance task performance. Despite these improvements, the number and quality of the studies and the outcomes used were limited. There is a need for longer term follow-up to establish trajectory of change and to determine if any gains are retained long term. The optimal delivery and content of exercise interventions (dosing, component exercises) at different stages of the disease are not clear.