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Background and Purpose. Exacerbation of movement disorders while doing 2 tasks (dual task performance) is a characteristic feature of Parkinson disease (PD). The aim of this investigation was to identify whether the type of secondary task (motor or cognitive) determined the severity of dual task interference. Subjects and Methods. Footstep patterns for 15 people with PD and 15 comparison subjects without PD were compared when they walked: (1) at a self-selected speed, (2) while simultaneously performing a motor task (coin transference), and (3) while simultaneously performing a cognitive task (digit subtraction). Gait speed, stride length, cadence, and the percentage of the gait cycle in double-limb stance (DS) were examined with a computerized stride analyzer. Results. When there was no second task, the mean stride length was less in the group with PD (1.29 m) than in the comparison group (1.51 m), and the mean gait speed was less in the group with PD (71.47 m/min) than in the comparison group (87.29 m/min). The mean cadence was less in the group with PD (110.79 steps/rain) than in the comparison group (115.81 steps/min). The percentage of the gait cycle in DS was greater in the group with PD (33.38%) than in the comparison group (31.21%). Both groups reduced their stride length and speed when they had to change from unitask performance to dual task performance and DS increased. For the group with PD, cadence also decreased. For both groups, the type of secondary task had a negligible effect on the performance decrement. Discussion and Conclusion. Although the performance of simultaneous motor or cognitive tasks compromised gait in people with PD, the type of secondary task was not a major determinant of the severity of dual task interference. [O'Shea S, Morris ME, Iansek R. Dual task interference during gait in people with Parkinson disease: effect of motor versus cognitive secondary tasks. Key Words: Aging, Dual tasks, Gait, Locomotion, Parkinson disease, Physical therapy., During many activities of daily living, people need to perform more than one task at a time. The capacity to do a second task (dual task performance) is highly advantageous [...]

Background and Purpose. Due to the high incidence of falls in people with idiopathic Parkinson's disease (PD), the assessment of standing balance is a key component of physical therapist evaluation. This study investigated performance on clinical tests of standing balance in subjects with and without PD. Subjects. The subjects were 10 persons with PD who had a history of falls (age range = 60 - 80 years), 10 persons with PD who had no history of falls (age range = 63 - 79 years), and 10 persons with no known neurological impairment (age range = 60 - 78 years) who served as a comparison group. Methods. Subjects were tested on their ability to maintain stability in 3 conditions: (1) steady standing (feet apart, feet together, tandem stance, step stance, and single-limb stance), (2) in response to perturbations generated by self-initiated movements (arm raise, functional reach, bend-reach, and step tests), and (3) in response to an external perturbation to upright stance (shoulder tug). Balance was measured at peak dosage in the levodopa medication cycle (in the morning) and 7 days later. Results. The mean Hoehn and Yahr Disability Scale score was 3.0 for the fallen with PD and 2.5 for the nonfallers with PD. Performance on the tandem stance, single-limb stance, functional reach, and shoulder tug tests demonstrated differences between the subjects with PD and the comparison group and between the fallers and nonfallers with PD. The results of these tests were highly repeatable over 7 days (ICC = .61 - .94). Conclusion and Discussion. Although there was a small sample size, performance was highly consistent across 7 days when testing occurred during peak dosage of levodopa. A small battery of tests were sensitive enough to discriminate between people with PD who fall and those with no history of falls. [Smithson F, Morris ME, Iansek R. Performance on clinical tests of balance in Parkinson's disease. Phys Ther. 1998;78:577-592.], Key Words: Balance, Movement disorders, Parkinson's disease, Postural control. Assessment of balance in standing is a key component of the physical therapist evaluation for people with idiopathic Parkinson's disease (PD). [...]

Background and Purpose. Evaluation of physical therapy for gait disorders in patients with Parkinson's disease (PD) requires an understanding of how the patients' medication cycle affects function. Four experiments were [...]

Motor program theory has provided physical therapists with one approach to understanding bow the brain controls movement Analogous with computer programs that specify the operations of computer hardware, motor programs are thought to contain commands for muscles that allow movements to occur without the need for continuous peripheral feedback. A review of the physical therapy literature reveals many instances in which motor program theory has been used as a theoretical framework for clinical practice. Yet despite the contribution programming theory has made to the advancement of movement science, the motor program construct is currently under considerable threat Keele's (1968) original definition no longer seems tenable, given the problem of program storage, motor equivalence, movement flexibility, and context-conditioned variability. The that researchers from different disciplines define the motor program in a variety ways adds difficulty to the task of evaluating the efficacy of the model. A critical appraisal of programming theory and its use in physical therapy suggests that clinicians need to reconsider the usefulness of the motor program model as a basis for movement rehabilitation following brain damage and musculoskeletal disorders [Morris ME, Summers JJ, Matyas TA Iansek R Current status of the motor program. Phys Ther. 1994;74:738-752.! Key Words: Motor skills, Movement, Movement disorders, Physical therapy, Rehabilitation., Whether training motor skills in elite athletes or in patients with orthopedic injuries or brain damage, therapists frequently refer to the motor program when seeking a theoretical framework for clinical [...]

Background and Purpose. The Timed "Up & Go" Test (TUG) is used to measure the ability of patients to perform sequential locomotor tasks that incorporate walking and turning. This study investigated the retest reliability, interrater reliability, and sensitivity of TUG scores in detecting changes in mobility in subjects with idiopathic Parkinson disease (PD). Subjects. The performance of 12 people with PD was compared with that of 12 age-matched comparison subjects without PD. Methods. The subjects with PD completed 5 trials of the TUG after withdrawal of levodopa for 12 hours ("off" phase of the medication cycle) as well as an additional 5 trials 1 hour after levodopa was administered ("on" phase of the medication cycle). They were scored on the Modified Webster Scale at both sessions. The comparison subjects also performed 5 TUG trials. All trials were videotaped and timed by 2 experienced raters. The videotape was later rated by 3 experienced clinicians and 3 inexperienced clinicians. Results. For the subjects with PD, within-session performance was highly consistent, with correlations (r) ranging from .80 to .98 for the "off" phase and from .73 to .99 for the "on" phase. The performance of the comparison subjects across the 5 trials was also highly consistent (r=.90-.97). Comparisons showed differences between trials 1 and 2 on the TUG for both groups. Removal of data for trial 1 (the practice trial) further enhanced retest reliability. There was close agreement in TUG scores among raters despite different levels of experience (intraclass correlation coefficient [3,1] =.87-.99). Mean TUG scores were different between the "on" and "off" phases of the levodopa cycle, and between subjects with PD and comparison subjects during the on phase. Conclusion and Discussion. Retest reliability and interrater reliability of the TUG measurements were high, and the measurements reflected changes in performance according to levodopa use. The TUG can also be used to detect differences in performance between people with PD and elderly people without PD. [Morris S, Morris ME, Iansek R. Reliability of measurements obtained with the Timed "Up & Go" Test in people with Parkinson disease. Phys Ther. 2001;81:810-818.] Key Words; Gait, Levodopa, Locomotion, Mobility, Parkinson disease, Physical therapy, Turning., Physical therapists play a major role in assessing the ability of people with Parkinson disease (PD) to perform complex motor tasks that are routinely performed in everyday life.[1-4] They also [...]