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Freezing of gait (FOG) is a debilitating symptom of Parkinson disease (PD). It is episodic and variable in nature, making assessment difficult. Wearable sensors used in conjunction with specialized algorithms, such as our group's pFOG algorithm, provide objective data to better understand this phenomenon. While these methods are effective at detecting FOG retrospectively, more work is needed. The purpose of this paper is to explore how the existing pFOG algorithm can be refined to improve the detection and prediction of FOG. To accomplish this goal, previously collected data were utilized to assess the prediction ability of the current algorithm, the potency of each FOG assessment task(s) for eliciting FOG, and the maintenance of detection accuracy when modifying the sampling rate. Results illustrate that the algorithm was able to predict upcoming FOG episodes, but false positive rates were high. The Go Out and Turn-Dual Task was most potent for eliciting FOG, and the 360-Dual Task elicited the longest duration of FOG. The detection accuracy of the pFOG algorithm was maintained at a sampling rate of 60 Hz but significantly worse at 30 Hz. This work is an important step in refining the pFOG algorithm for improved clinical utility. [ABSTRACT FROM AUTHOR]

Purpose: To understand therapeutic priorities, a secondary data analysis on a retrospective cohort was conducted to classify rehabilitation goals according to the International Classification of Functioning, Disability, and Health (ICF). Materials and Methods: Therapeutic goals from an initial outpatient physical or occupational therapy evaluation for patients post-stroke or with Parkinson disease, were classified into Level 1 of the ICF. Goals in the Activity and Participation component were further sub-classified as activity capacity or activity performance (self-report or direct) in daily life. Results: 776 goals across 104 participants were classified into Level 1 of the ICF. The majority, 73% (563/776) were classified as Activity and Participation, 20% (155/776) as Body Function and 2% (17/776) as Environmental Factors. Fifty-two percent (400/776) of all goals were classified as activity capacity and 21% (163/776) as activity performance in daily life, with 21% (160/776) of goals measuring self-report activity performance in daily life and less than 1% (3/776) of goals measuring direct activity performance in daily life. Conclusions: While the majority of therapeutic goals were classified into the Activity and Participation component, less than 1% of goals measured direct activity performance in daily life. If people seek outpatient rehabilitation to improve functioning in their real-world environment, therapeutic goal setting should reflect this. PREVIOUS PRESENTATION WORK: Portions of this content were presented at the 2023 Academy of Neurologic Physical Therapy Annual Conference and will be presented at the 2023 TIRR & UT Health International Stroke Rehab & Recovery Conference. IMPLICATIONS FOR REHABILITATION: The majority of therapeutic goals for an episode of outpatient neurorehabilitation were classified into the Activity and Participation component of the International Classification of Functioning, Disability, and Health. However, less than 1% of therapeutic goals measured direct activity performance in daily life. If people with neurological diagnoses seek out outpatient rehabilitation to improve functioning in their real-world environment, than therapeutic goal setting should reflect this. [ABSTRACT FROM AUTHOR]

Advances in medical management of Parkinson's disease (PD) have resulted in living longer with disability. Although disability worsens over the course of the disease, there are signs of disability even in the early stages. Several studies reveal an early decline in gait and balance and a high prevalence of nonmotor signs in the prodromal period that contribute to early disability. There is a growing body of evidence revealing the benefits of physical therapy and exercise to mitigate motor and nonmotor signs while improving physical function and reducing disability. The presence of early disability coupled with the benefits of exercise suggests that physical therapy should be initiated earlier in the disease. In this review, we present the evidence revealing early disability in PD and the effectiveness of physical therapy and exercise, followed by a discussion of a secondary prevention model of rehabilitation to reduce early disability and optimize long-term outcomes. [ABSTRACT FROM AUTHOR]

People with Parkinson disease (PD) demonstrate improvements in motor function following group tango classes, but report long commutes as a barrier to participation. To increase access, we investigated a telerehabilitation approach to group tango instruction. Twenty-six people with mild-to-moderate PD were assigned based on commute distance to either the telerehabilitation group (Telerehab) or an in-person instruction group (In-person). Both groups followed the same twice-weekly, 12-week curriculum with the same instructor. Feasibility metrics were participant retention, attendance and adverse events. Outcomes assessed were balance, PD motor sign severity and gait. Participant retention was 85% in both groups. Attendance was 87% in the Telerehab group and 84% in the In-person group. No adverse events occurred. Balance and motor sign severity improved significantly over time ( p < 0.001) in both groups, with no significant group × time effects. Gait did not significantly change. Since a priori feasibility criteria were met or exceeded, and there were no notable outcome differences between the two instruction approaches, this pilot study suggests a telerehabilitation approach to group tango class for people with PD is feasible and may have similar outcomes to in-person instruction. [ABSTRACT FROM AUTHOR]

Background: The natural progression of balance decline in individuals with Parkinson disease (PD) is not well understood. Objectives: We aimed to: 1) compare the utility of three standardized clinical measures for detecting balance decline over 1-year, 2) identify components of balance susceptible to decline, and 3) identify factors useful for predicting future balance decline. Methods: Eighty people with PD (59% male; mean age 68.2 ± 9.3; Hoehn & Yahr range I-IV) completed Balance Evaluation Systems Test (BESTest), Mini-BESTest, and Berg Balance Scale (BBS) assessments. Baseline predictor variables included the MDS-UPDRS III sub-score, presence of freezing, 6-month fall history, age, gender, and physical activity. Balance and MDS-UPDRS III assessments were repeated at 6 (n = 51) and 12 months (n = 44). Results: BESTest and Mini-BESTest score declined over 6 and 12 months (P < 0.01). Postural responses, stability limits, and sensory orientation were most susceptible to decline. BBS score did not change (P > 0.01). MDS-UPDRS III score was unchanged over 6 months (P > 0.01), but declined over 12 months (P < 0.01). Change in BESTest score over 6 months was related to baseline MDS-UPDRS III, H&Y, freezing, and fall history (P < 0.05). Change in BESTest score over 12 months was related to baseline MDS-UPDRS III and freezing (P < 0.05). Change in Mini-BESTest over 12 months was related to baseline MDS-UPDRS III and age (P < 0.05). Conclusions: The BESTest and Mini-BESTest were responsive to balance decline in individuals with PD and helped to identify decline in underlying balance components. Disease severity and freezing most consistently predicted balance decline in persons with PD. [ABSTRACT FROM AUTHOR]

Background: Effective treatment of locomotor dysfunction in Parkinson disease (PD) is essential, as gait difficulty is an early and major contributor to disability. Exercise is recommended as an adjunct to traditional treatments for improving gait, balance, and quality of life. Among the exercise approaches known to improve walking, tango and treadmill training have recently emerged as two promising therapies for improving gait, disease severity and quality of life, yet these two interventions have not been directly compared to each other. Prior studies have been helpful in identifying interventions effective in improving gait function, but have done little to elucidate the neural mechanisms underlying functional improvements. The primary objective of the proposed work is to compare the effects of three community-based exercise programs, tango, treadmill training and stretching, on locomotor function in individuals with PD. In addition, we aim to determine whether and how these interventions alter functional connectivity of locomotor control networks in the brain. Methods/Design: One hundred and twenty right-handed individuals with idiopathic PD who are at least 30 years of age will be assigned in successive waves to one of three community-based exercise groups: tango dancing, treadmill training or stretching (control). Each group will receive three months of exercise training with twice weekly one-hour group classes. Each participant will be evaluated at three time points: pre-intervention (baseline), post-intervention (3 months), and follow-up (6 months). All evaluations will include assessment of gait, balance, disease severity, and quality of life. Baseline and post-intervention evaluations will also include task-based functional magnetic resonance imaging (fMRI) and resting state functional connectivity MRI. All MRI and behavioral measures will be conducted with participants OFF anti-Parkinson medication, with behavioral measures also assessed ON medication. Discussion: This study will provide important insights regarding the effects of different modes of exercise on locomotor function in PD. The protocol is innovative because it: 1) uses group exercise approaches for all conditions including treadmill training, 2) directly compares tango to treadmill training and stretching, 3) tests participants OFF medication, and 4) utilizes two distinct neuroimaging approaches to explore mechanisms of the effects of exercise on the brain. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To determine the effects of a 12-month community-based tango dance program on activity participation among individuals with Parkinson''s disease (PD). Design: Randomized controlled trial with assessment at baseline, 3, 6, and 12 months. Setting: Intervention was administered in the community; assessments were completed in a university laboratory. Participants: Volunteers with PD (n=62) enrolled in the study and were randomized to a treatment group; 10 participants did not receive the allocated intervention, and therefore the final analyzed sample included 52 participants. Interventions: Participants were randomly assigned to the tango group, which involved 12 months of twice-weekly Argentine tango dance classes, or to the no intervention control group (n=26 per group). Main Outcome Measure: Current, new, and retained participation in instrumental, leisure, and social activities, as measured by the Activity Card Sort (with the dance activity removed). Results: Total current participation in the tango group was higher at 3, 6, and 12 months compared with baseline (Ps≤.008), while the control group did not change (Ps≥.11). Total activity retention (since onset of PD) in the tango group increased from 77% to 90% (P=.006) over the course of the study, whereas the control group remained around 80% (P=.60). These patterns were similar in the separate activity domains. The tango group gained a significant number of new social activities (P=.003), but the control group did not (P=.71). Conclusions: Individuals with PD who participated in a community-based Argentine tango class reported increased participation in complex daily activities, recovery of activities lost since the onset of PD, and engagement in new activities. Incorporating dance into the clinical management of PD may benefit participation and subsequently quality of life for this population. [Copyright &y& Elsevier]

Purpose. Motor freezing, the inability to produce effective movement, is associated with decreasing amplitude, hastening of movement, and poor coordination. We investigated how manipulations of movement amplitude and cadence affect upper extremity (UE) coordination as measured by the phase coordination index (PCI)-only previously measured in gait-and freezing of the upper extremity (FO-UE) in people with Parkinson's disease (PD) who experience freezing of gait (PD + FOG), do not experience FOG (PD-FOG), and healthy controls. Methods. Twenty-seven participants with PD and 18 healthy older adults made alternating bimanual movements between targets under four conditions: Baseline; Fast; Small; SmallFast. Kinematic data were recorded and analyzed for PCI and FO-UE events. PCI and FO-UE were compared across groups and conditions. Correlations between UE PCI, gait PCI, FO-UE, and Freezing of Gait Questionnaire (FOG-Q) were determined. Results. PD+ FOG had poorer coordination than healthy old during SmallFast. UE coordination correlated with number of FO-UE episodes in two conditions and FOG-Q score in one. No differences existed between PD−/+FOG in coordination or number of FO-UE episodes. Conclusions. Dyscoordination and FO-UE can be elicited by manipulating cadence and amplitude of an alternating bimanual task. It remains unclear whether FO-UE and FOG share common mechanisms. [ABSTRACT FROM AUTHOR]

Background. Tango dancing has been effective in improving measures of physical function in people with Parkinson disease (PD). However, all previous studies were institution-based, tested participants on medication, and employed short-term interventions. Objective. To determine the effects of a 12-month community-based tango program for individuals with PD on disease severity and physical function. Methods. Sixty-two participants were randomly assigned to a twice weekly, community-based Argentine Tango program or a Control group (no intervention). Participants were assessed off anti-Parkinson medication at baseline, 3, 6, and 12 months. The primary outcome measure was the Movement Disorders Society–Unified Parkinson Disease Rating Scale 3 (MDS-UPDRS-3). Secondary outcome measures were the MDS-UPDRS-1, MDS-UPDRS-2, MiniBESTest balance test; Freezing of Gait Questionnaire (FOG_Q); 6-Minute Walk Test (6MWT); gait velocity for comfortable forward, fast as possible forward, dual task, and backward walking; and Nine-Hole Peg Test (9HPT). Results. Groups were not different at baseline. Overall, the Tango group improved whereas the Control group showed little change on most measures. For the MDS-UPDRS-3, there was no significant change in the Control group from baseline to 12 months, whereas the Tango group had a reduction of 28.7% (12.8 points). There were significant group by time interactions for MDS-UPDRS-3, MiniBESTest, FOG_Q, 6MWT, forward and dual task walking velocities, and 9HPT in favor of the dance group. Conclusions. Improvements in the Tango group were apparent off medication, suggesting that long-term participation in tango may modify progression of disability in PD. [ABSTRACT FROM PUBLISHER]

Abstract: Duncan RP, Leddy AL, Earhart GM. Five times sit-to-stand test performance in Parkinson''s disease. Objectives: To (1) determine intrarater and test-retest reliability of the Five times sit-to-stand test (FTSTS) in Parkinson''s disease (PD), (2) characterize FTSTS performance in PD at different disease stages, (3) determine predictors of FTSTS performance in PD, and (4) determine the utility of the FTSTS for discriminating between fallers and nonfallers with PD, identifying an appropriate cutoff score to delineate between these groups. Design: Measurement study of community-dwelling individuals with idiopathic PD. Setting: A medical school laboratory. Participants: Participants (N=82) were recruited via population-based sampling. The final sample included 80 participants. Two were excluded because of exclusion criteria and an unrelated illness, respectively. Interventions: Not applicable. Main Outcome Measures: FTSTS time (seconds) was the primary outcome measure. Secondary outcome measures included the Mini-Balance Evaluation Systems Test (Mini-BEST), Maximal Voluntary Isometric Contraction–Quadriceps, 9-Hole Peg Test (9HPT), 6-minute walk, Freezing of Gait Questionnaire, Activities-Specific Balance Confidence Scale, Physical Activity Scale for the Elderly, Parkinson''s Disease Questionnaire-39, and Movement Disorders Society–Unified Parkinson''s Disease Rating Scale. Results: Interrater and test-retest reliability for the FTSTS were high (intraclass correlation coefficients: .99 and .76, respectively). Mean FTSTS performance was 20.25±14.12 seconds. All mobility measures were significantly correlated with FTSTS (P<.01). The Mini-BEST and 9HPT together explained 53% of the variance in FTSTS. Receiver operating characteristic analysis determined a cutoff of 16.0 seconds (sensitivity, .75; specificity, .68) for discriminating between fallers and nonfallers, with an area under the curve of .77. Conclusions: The FTSTS is a quick, easily administered measure that is useful for gross determination of fall risk in individuals with PD. [Copyright &y& Elsevier]

Abstract: Auditory and attentional cues improve gait in Parkinson disease (PD), but it is unclear if combining the two cueing strategies offers additional benefit. Further, the effect of a secondary cognitive task on cue efficacy is unknown. Therefore, this study aimed to assess the effects of cue type and task complexity on gait in PD. 11 participants with PD, 11 age-matched controls, and 11 young controls performed 3 walking trials on a GAITRite walkway under the following cueing conditions: no cue (baseline), rhythmic auditory cue at 10% below (AUD−10) and 10% above (AUD+10) self selected cadence, attentional cue (ATT; “take long strides”), and a combination of AUD and ATT (COM−10, COM+10). Each condition was also performed concurrently with a secondary word generation task (dual task, DT). Baseline gait velocity and stride length were less for those with PD and age-matched controls compared to young controls, and the ability of those with PD to use cues differed from the other groups. Gait velocity and stride length increased in PD with ATT, but not with auditory cues. Similar increases in gait velocity and stride length were observed with the combined cues, but additional benefit beyond ATT alone was not observed. Cues did not improve gait velocity during dual task walking, although stride length did increase with COMB+10. It appears persons with PD are able to benefit from attentional cueing and can combine attentional and auditory cues, but do not gain additional benefit from such a combination. During walking while performing a secondary cognitive task, attentional cues may help to facilitate a longer stride length. [Copyright &y& Elsevier]

Summary: Objective: The goal of this pilot study was to determine the effects of short duration, intensive tango lessons on functional mobility in people with Parkinson disease. Design: This study employed a within-subject, prospective, repeated measures design. Subjects/patients: Fourteen people with idiopathic Parkinson disease participated. Setting: All balance and gait assessments were performed in a laboratory, but dance classes took place in a large, open classroom. Interventions: Participants completed ten 1.5-h long Argentine tango dance lessons within 2 weeks. Their balance, gait and mobility were assessed before and after the training sessions. Main outcome measures: Measures included the Berg Balance Scale, the Unified Parkinson Disease Rating Scale, gait velocity, functional ambulation profile, step length, stance and single support percent of gait, Timed Up and Go, and the 6min walk. Results: Participants significantly improved on the Berg Balance Scale (effect size (ES)=0.83, p =0.021), Unified Parkinson Disease Rating Scale Motor Subscale III (ES=−0.64, p =0.029), and percent of time spent in stance during forward walking (ES=0.97, p =0.015). Non-significant improvements were noted on the Timed Up and Go (ES=−0.38, p =0.220) and 6min walk (ES=0.35, p =0.170). Conclusions: Frequent social dance lessons completed within a short time period appear to be appropriate and effective for these individuals with mild-moderately severe Parkinson disease. [Copyright &y& Elsevier]

Abstract: Falvo MJ, Earhart GM. Six-minute walk distance in persons with Parkinson disease: a hierarchical regression model. Objectives: To determine the six-minute walk distance (6MWD) in subjects with Parkinson disease (PD) and to determine the impairments that contribute to walking capacity. Design: Descriptive cross-sectional study of subjects with PD. Setting: University laboratory. Participants: Subjects with PD (N=75; 65.0±9.5y) of mild to moderate severity, as defined by an average Hoehn and Yahr (HY) rating of 2.0±0.4 and Unified Parkinson Disease Rating Scale (UPDRS) motor score of 27±8.9, were tested on medication. Interventions: Not applicable. Main Outcome Measures: Subjects were administered the motor subsection of the UPDRS and completed the following tests: Berg Balance Scale (BBS), Timed Up & Go (TUG), and six-minute walk test. In addition, they also provided self-reports of freezing of gait and number of falls in the past 6 months. Results: The average 6MWD was 391.6±99.9m. All of the aforementioned tests, with the exception of fall number (P=.07), correlated significantly with 6MWD (r range, −.64 to .55). By using a hierarchical regression model, we entered age, HY, and UPDRS motor score into the first block (ie, set of independent variables) to represent parkinsonian characteristics, which explained a significant amount of variability in 6MWD (R 2=.196, P<.001). The second block entered (eg, functional measures scores, self-reports) explained a significant amount of additional variability (R 2 change=.355, P<.001). The TUG, BBS, and number of falls contributed independently in the presence of all independent variables. Conclusions: The 6MWD in subjects with PD is explained in part by disease-specific characteristics and perhaps to a greater extent by impaired balance and predisposition to falling. Training targeted at improving balance and reducing falling risk factors may increase 6MWD (ie, walking capacity) in subjects with PD. [Copyright &y& Elsevier]

An introduction is presented in which the editor discusses several reports within the issue on topics including controlled trials of exercise or motor training in Parkinson's disease, medications on gait-related mobility and evidence-based rehabilitation in different settings.

Parkinson's disease (PD) is a disabling neurodegenerative disease whose manifestations span motor, sensorimotor, and sensory domains. While current therapies for PD include pharmacological, invasive, and physical interventions, there is a constant need for developing additional approaches for optimizing rehabilitation gains. Mental imagery is an emerging field in neurorehabilitation and has the potential to serve as an adjunct therapy to enhance patient function. Yet, the literature on this topic is sparse. The current paper reviews the motor, sensorimotor, and sensory domains impacted by PD using gait, balance, and pain as examples, respectively. Then, mental imagery and its potential for PD motor and non-motor rehabilitation is discussed, with an emphasis on its suitability for addressing gait, balance, and pain deficits in people with PD. Lastly, future research directions are suggested. [ABSTRACT FROM AUTHOR]

Objective To examine fall risk trajectories occurring naturally in a sample of individuals with early to middle stage Parkinson disease (PD). Design Latent class analysis, specifically growth mixture modeling (GMM), of longitudinal fall risk trajectories. Setting Assessments were conducted at 1 of 4 universities. Participants Community-dwelling participants with PD of a longitudinal cohort study who attended at least 2 of 5 assessments over a 2-year follow-up period (N=230). Interventions Not applicable. Main Outcome Measures Fall risk trajectory (low, medium, or high risk) and stability of fall risk trajectory (stable or fluctuating). Fall risk was determined at 6 monthly intervals using a simple clinical tool based on fall history, freezing of gait, and gait speed. Results The GMM optimally grouped participants into 3 fall risk trajectories that closely mirrored baseline fall risk status ( P =.001). The high fall risk trajectory was most common (42.6%) and included participants with longer and more severe disease and with higher postural instability and gait disability (PIGD) scores than the low and medium fall risk trajectories ( P <.001). Fluctuating fall risk (posterior probability <0.8 of belonging to any trajectory) was found in only 22.6% of the sample, most commonly among individuals who were transitioning to PIGD predominance. Conclusions Regardless of their baseline characteristics, most participants had clear and stable fall risk trajectories over 2 years. Further investigation is required to determine whether interventions to improve gait and balance may improve fall risk trajectories in people with PD. [ABSTRACT FROM AUTHOR]

• We examined the effects of different cue types on gait, finger tapping, and foot tapping to determine whether tapping can be used as a surrogate for gait in future neuroimaging studies. • External, not self-generated cues increased variability across movements and groups. • Finger tapping may be an adequate proxy for gait to study differences in cue types. • Groups did not differ in rhythm skills or auditory imagery scores. • Higher beat perception was associated with lower variability in tapping but not gait. Rhythmic auditory cueing has been widely studied for gait rehabilitation in Parkinson's disease (PD). Our research group previously showed that externally generated cues (i.e., music) increased gait variability measures from uncued gait, whereas self-generated cues (i.e., mental singing) did not. These different effects may be due to differences in underlying neural mechanisms that could be discerned via neuroimaging; however, movement types that can be studied with neuroimaging are limited. The primary aim of the present study was to investigate the effects of different cue types on gait, finger tapping, and foot tapping, to determine whether tapping can be used as a surrogate for gait in future neuroimaging studies. The secondary aim of this study was to investigate whether rhythm skills or auditory imagery abilities are associated with responses to these different cue types. In this cross-sectional study, controls (n = 24) and individuals with PD (n = 33) performed gait, finger tapping, and foot tapping at their preferred pace (UNCUED) and to externally generated (MUSIC) and self-generated (MENTAL) cues. Spatiotemporal parameters of gait and temporal parameters of finger tapping and foot tapping were collected. The Beat Alignment Task (BAT) and Bucknell Auditory Imagery Scale (BAIS) were also administered. The MUSIC cues elicited higher movement variability than did MENTAL cues across all movements. The MUSIC cues also elicited higher movement variability than the UNCUED condition for gait and finger tapping. This study shows that different cue types affect gait and finger tapping similarly. Finger tapping may be an adequate proxy for gait in studying the underlying neural mechanisms of these cue types. [ABSTRACT FROM AUTHOR]