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To explore the physical activity of people with Parkinson's disease (PD) with subthalamic nucleus deep brain stimulation (STN-DBS) and investigate factors associated with physical activity. Twenty-four participants who had STN-DBS for one or more years were recruited. Eligibility criteria included Hoehn and Yahr stage ≤ 4, continuation of STN-DBS, living at home and able to provide informed consent. Physical activity was measured using the self-report physical activity scale for the elderly (PASE). Motor and non-factors that influence physical activity in PD, such as gait disturbance and mood, were recorded using clinical measures. Participants had long-standing PD of moderate severity, mean Hoehn and Yahr 2.3, and mild to moderate functional disability, MDS-UPDRS M-EDL mean 16.2. PASE scores were significantly lower compared to norms for adults ≤ 70 years (115.2 versus 143, p= 0.045). There was a significant negative correlation between PASE scores and falls history, fatigue, fear of falling (FOF) and quality of life (p < 0.05). This study provides further evidence that physical activity levels in PD with STN-DBS remain low compared to PASE norms for older adults. Future research investigating interventions to improve factors associated with low physical activity levels should be considered. Despite the benefits of deep brain stimulation (DBS) on motor function and activities of daily living, physical activity levels remain low in people with Parkinson's disease (PD) with subthalamic nucleus (STN)-DBS compared to norms for older adults. A history of falls, greater fear of falling (FOF) and higher levels of fatigue are associated with lower levels of physical activity in people with PD with STN-DBS. When planning rehabilitation interventions consideration should be given to strategies that promote and support regular physical activity for people with PD with STN-DBS. Rehabilitation clinicians should consider using falls prevention programmes and include strategies to decrease FOF for people with PD with STN-DBS. Consideration should be given to the presence of fatigue when planning the rehabilitation programme for the person with PD with STN-DBS. [ABSTRACT FROM AUTHOR]

To investigate the feasibility and acceptability of the Health and Fitness Program (HFP), a long-term community gym program for people with mild to moderate Parkinson's disease (PD). Physiotherapists, with PD expertise, developed individualised exercise programs for new HFP members in consultation with them. Gym instructors, with PD training, supervised the HFP sessions. Exercises included progressive strength training, aerobic, balance, and stretching. Participants who had been enrolled in the HFP for 12 months, were recruited to a single group pre/post design study to test the program's feasibility and acceptability. Feasibility included safety, retention, attendance, and compliance data and acceptability measured using a customised questionnaire. 17 of the 20 HFP members enrolled maintained membership for 12 months and participated in this study. The program was shown to be feasible with no falls reported during sessions, only one participant reported pain from exercising lasting more than 48 h, retention was high (85%) and most members complied with their program. Overall satisfaction with the program was high, with seven somewhat satisfied and 10 very satisfied. The HFP demonstrated that a PD community gym program is feasible and acceptable when physiotherapists and PD-trained instructors collaborate to provide individualized exercise programs. People with Parkinson's disease need support to maintain long-term adherence to regular exercise which can be achieved with supervised community-based gym programs. A community-based PD-specific exercise program can be safe and acceptable to people with PD when PD specialist physiotherapists are involved in planning participants' exercise programs and PD-trained gym instructors supervise the exercise sessions. Members are satisfied with programs that have strategies in place to minimise barriers to participation, such as keeping costs to members low, providing a quality service, having supportive trained staff, and creating opportunities for social interaction between members. Evidence-based community exercise programs may result in improved strength and aerobic fitness and maintain quality of life in people with mild to moderate PD however further research using an RCT study is needed. [ABSTRACT FROM AUTHOR]

Abstract Background The relationship between health-related quality of life (HRQoL) in people with Parkinson’s disease and their caregivers is little understood and any effects on caregiver strain remain unclear. This paper examines these relationships in an Australian sample. Methods Using the generic EuroQol (EQ-5D) and disease-specific Parkinson’s Disease Questionnaire-39 Item (PDQ-39), HRQoL was evaluated in a sample of 97 people with PD and their caregivers. Caregiver strain was assessed using the Modified Caregiver Strain Index. Associations were evaluated between: (i) caregiver and care-recipient HRQoL; (ii) caregiver HRQoL and caregiver strain, and; (iii) between caregiver strain and care-recipient HRQoL. Results No statistically significant relationships were found between caregiver and care-recipient HRQoL, or between caregiver HRQoL and caregiver strain. Although this Australian sample of caregivers experienced relatively good HRQoL and moderately low strain, a significant correlation was found between HRQoL of people with PD and caregiver strain (rho 0.43, p Conclusion Poor HRQoL in people with PD is associated with higher strain in caregivers. Therapy interventions may target problems reported as most troublesome by people with PD, with potential to reduce strain on the caregiver.

Abstract Background The high incidence of falls associated with Parkinson’s disease (PD) increases the risk of injuries and immobility and compromises quality of life. Although falls education and strengthening programs have shown some benefit in healthy older people, the ability of physical therapy interventions in home settings to reduce falls and improve mobility in people with Parkinson’s has not been convincingly demonstrated. Methods/design 180 community living people with PD will be randomly allocated to receive either a home-based integrated rehabilitation program (progressive resistance strength training, movement strategy training and falls education) or a home-based life skills program (control intervention). Both programs comprise one hour of treatment and one hour of structured homework per week over six weeks of home therapy. Blinded assessments occurring before therapy commences, the week after completion of therapy and 12 months following intervention will establish both the immediate and long-term benefits of home-based rehabilitation. The number of falls, number of repeat falls, falls rate and time to first fall will be the primary measures used to quantify outcome. The economic costs associated with injurious falls, and the costs of running the integrated rehabilitation program from a health system perspective will be established. The effects of intervention on motor and global disability and on quality of life will also be examined. Discussion This study will provide new evidence on the outcomes and cost effectiveness of home-based movement rehabilitation programs for people living with PD. Trial registration The trial is registered on the Australian and New Zealand Clinical Trials Registry (ACTRN12608000390381).

Abstract Background Although physical therapy and falls prevention education are argued to reduce falls and disability in people with idiopathic Parkinson's disease, this has not yet been confirmed with a large scale randomised controlled clinical trial. The study will investigate the effects on falls, mobility and quality of life of (i) movement strategy training combined with falls prevention education, (ii) progressive resistance strength training combined with falls prevention education, (iii) a generic life-skills social program (control group). Methods/Design People with idiopathic Parkinson's disease who live at home will be recruited and randomly allocated to one of three groups. Each person shall receive therapy in an out-patient setting in groups of 3-4. Each group shall be scheduled to meet once per week for 2 hours for 8 consecutive weeks. All participants will also have a structured 2 hour home practice program for each week during the 8 week intervention phase. Assessments will occur before therapy, after the 8 week therapy program, and at 3 and 12 months after the intervention. A falls calendar will be kept by each participant for 12 months after outpatient therapy. Consistent with the recommendations of the Prevention of Falls Network Europe group, three falls variables will be used as the primary outcome measures: the number of fallers, the number of multiple fallers and the falls rate. In addition to quantifying falls, we shall measure mobility, activity limitations and quality of life as secondary outcomes. Discussion This study has the potential to determine whether outpatient movement strategy training combined with falls prevention education or progressive resistance strength training combined with falls prevention education are effective for reducing falls and improving mobility and life quality in people with Parkinson's disease who live at home. Trial registration Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12606000344594

View Supplementary Videos , , Background Freezing of gait ( FOG) in Parkinson's disease ( PD) is poorly understood; however, with the established understanding of basal ganglia function, its manifestations should be more easily interpretable. This review examines freezing of gait ( FOG) from such a perspective. Methods A search of the MEDLINE and EMBASE databases from the year 2000 onward for review articles, focused on the pathophysiology of FOG, was used to determine current concepts. A previously established model of basal ganglia function was used to determine the concepts' validities. At the core of the model are deficits in motor set maintenance and timing cue production for automatic movement. It includes the shift between attention and automation to the predominant attention control of gait in PD. Results The difficulties of the found concepts to explain FOG stem from failure to characterize different FOG components, from the assumption that all components share a similar pathophysiology, from a failure to separate basic deficits from compensatory mechanisms, and from the assumption that cognitive deficits are the cause of FOG rather than representing an inadequate compensation to FOG. Pragmatic approaches to management use the attention shift, with the provision of visual information about correct amplitude of step to correct initiation deficits, and motor blocks during gait. It also emphasizes the need to prevent step length reduction on turns, environmental situations, and cognitive overload. Conclusion The concept of automatic deficits in set maintenance and cue production best describe FOG manifestations in PD and, with the use of attention, the concept also provides pragmatic strategies for management. [ABSTRACT FROM AUTHOR]

Background The progressive deterioration of gait in Huntington's disease (HD) leads to functional decline and loss of function. To understand the underlying mechanisms responsible for the gait changes in HD, we examined the automatic control of gait by measuring the relationship between stride length and cadence. The relationship is strongly linked in healthy adults during automatic gait but disrupted in pathological gait disorders, such as Parkinson's disease (PD). Methods The stride length cadence relationship was compared between seventeen participants with HD, twenty with PD and twenty one healthy older adults (HOA). Participants had their gait recorded at self-selected preferred, very slow, slow, fast and very fast speeds. Linear regression analysis was used to determine the slope and intercept of the relationship which were compared between groups. The adjustment of stride length and cadence when changing gait speeds was measured and compared within and between groups. Results Linearity was strong in all but two participants with HD and one with PD. Slope did not differ between groups (p > 0.05) but intercept was lower in the HD and PD groups compared to HOA (p < 0.05). Stride length was shorter in the HD and PD groups compared to controls at preferred and most adjusted speed conditions (p < 0.05) but cadence did not differ between groups (p > 0.05) regardless of speed. The HD group adjusted stride length and cadence similar to HOA when changing speed. The range of cadence across speed conditions did not differ between groups. Conclusion Scaling of stride length but not the regulation of cadence was found to be disrupted in participants with HD. [ABSTRACT FROM AUTHOR]