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Background: Despite the finding that Parkinson disease (PD) occurs in more than one in every 1000 people older than 60 years, there have been few attempts to quantify how deficits in impairments, activity, participation, and quality of life progress in this debilitating condition. It is unclear which tools are most appropriate for measuring change over time in PD. Methods and design: This protocol describes a prospective analysis of changes in impairments, activity, participation, and quality of life over a 12 month period together with an economic analysis of costs associated with PD. One-hundred participants will be included, provided they have idiopathic PD rated I-IV on the modified Hoehn & Yahr (1967) scale and fulfil the inclusion criteria. The study aims to determine which clinical and economic measures best quantify the natural history and progression of PD in a sample of people receiving services from the Victorian Comprehensive Parkinson's Program, Australia. When the data become available, the results will be expressed as baseline scores and changes over 3 months and 12 months for impairment, activity, participation, and quality of life together with a cost analysis. Discussion(s): This study has the potential to identify baseline characteristics of PD for different Hoehn & Yahr stages, to determine the influence of disease duration on performance, and to calculate the costs associated with idiopathic PD. Valid clinical and economic measures for quantifying the natural history and progression of PD will also be identified. Trial Registration.

Background: Post stroke spasticity is common, and may affect function. Spastic muscles are identified by differential resistance to rapid and slow muscle lengthening. Once identified, spastic muscles may be treated with Botulinum Toxin A (BoNT-A) injections, which are muscle specific and costly. The efficacy of BoNT-A injections depends on assessment accuracy may be. Aim(s): To examine the efficacy of clinical assessment of adults' lower leg spasticity in studies of instrumental gait analysis. Method(s): Six databases were searched to identify studies where adult participants with lower limb spasticity were assessed with instrumental gait analyses. We identified the spasticity assessment tools used and the muscles tested. Result(s): Thirty-seven studies were included. Spasticity assessment used: * Modified Ashworth Scale n=32 * Modified Tardieu Scale n=5 * Duncan-Ely test n=3 * Multiple measurements n=5 * Other n=2 Muscles assessed: 9. Ankle plantar-flexors n=22, 10. Gastrocnemius n=5, 11. Soleus n=2, 12. Tibialis-Posterior n=1, 13. Rectus-Femoris n=5, 14. Quadriceps n=9, 15. Hamstrings n=6, 16. Unspecified n=4 In most studies muscles were tested in functional groups: * Ankle Plantar-Flexors n=25 * Knee extensors n=14 * Knee flexors n=6 * Multiple muscle groups n=12 Conclusion(s): The Modified Ashworth Scale is commonly used for assessing spasticity, despite lack of differentiation between resistance to rapid and slow muscle lengthening. Plantar-flexors were most frequently tested, often with no attempts to differentiate between individual muscles. Knee extensors were tested infrequently, despite the prevalence of stiff knee gait. Spasticity assessment in instrumental gait analysis studies is poorly reported and should be conducted comprehensively (all possible muscle groups) and systematically (muscle specific).

Background: Biomechanical data in cerebral palsy are inherently variable but no optimal model of translational joint constraint has been identified. The primary aim of this study was to determine which model of translational joint constraint resulted in the lowest within-participant variability of lower limb joint angles and moments. The secondary aim was to determine which model best distinguished known functional groups in Cerebral Palsy. Method(s): Three models (three degrees of freedom, six degrees of freedom and six degrees of freedom with specified joint translation constraint) were applied to data from running trials of 40 children with cerebral palsy. Finding(s): Joint angle standard deviations were largest using the six degrees of freedom model and smallest using the constrained six degrees of freedom model (p < 0.050). For all joints in all planes of motion, joint moment standard deviations were largest using the six degrees of freedom model and smallest using the constrained six degrees of freedom model; standard deviations using the constrained model were smaller than the three degrees of freedom model by 10-30% of moment magnitude (0.01-0.03 Nm/kg; p < 0.001). The six degrees of freedom models distinguished functional subgroups with larger effect size than the three degrees of freedom model only for hip power generation in swing. Interpretation(s): A model with specified joint constraint minimized within-participant variability during running and was useful for detecting differences in functional capacity in cerebral palsy.Copyright © 2019 Elsevier Ltd

Background: Upper motor neuron lesions may cause spasticity (impairment), which may affect walking (function). The current literature is inconclusive regarding whether lower limb spasticity affects walking. Instrumental gait analyses (GA) provide a detailed analysis of walking. Aim(s): To conduct a systematic review to identify the spatiotemporal, kinematic and kinetic parameters used in instrumental GA for assessing adults with lower limb spasticity. Method(s): Six data bases were searched with inclusion criteria of empirical studies, adult participants, reported measurements of lower limb spasticity and instrumental GA. At least two independent investigators reviewed each paper, and rated its quality. Result(s): Thirty-seven studies were included: 17 pre-post intervention (71% fair quality), 15 observational (73% fair), 4 controlled intervention (75% good) and 1 case study (poor). Total participants n=766 (489 Stroke, 102 Hereditary Spastic Paraparesis, 65 Traumatic Brain Injury, 46 Spinal Cord Injury, 64 other). Spasticity was mainly assessed with the Modified Ashworth Scale n=32. Main spatiotemporal parameters: gait velocity (n=30), cadence (n=15), step/stride length (n=15), width (n=7), and double limb support (n=6). Main kinematic parameters: total joint excursion (n=11), peak joint angles (n=16), joint angles at heel-strike/toe-off/mid-stance (n=8) and angular velocity (n=8). Multiple kinetic parameters were studied, most common being peak moment (n=4) and peak power (n=3). In 12 studies electromyography data supplemented instrumental GA data. Conclusion(s): Spatiotemporal and kinematic data were the most comprehensively studied instrumented GA outcome measures. Findings suggest that spasticity affects function, primarily the parameters that impact the speed of walking.

Background: Three-dimensional gait analysis (3DGA) has not previously been considered by consensus panels of spinal cord experts for use in studies of patients with spinal cord damage (SCD), yet it is frequently used in other neurological populations, such as stroke and cerebral palsy. Research question: How does 3DGA impairment based reporting guide individualised clinical decision-making in people with incomplete SCD? Methods: Retrospective open cohort case series recruited 48 adults with incomplete SCD (traumatic or non-traumatic spinal cord dysfunction) referred to the Clinical Gait Analysis Service (CGAS), Melbourne, Australia. Three-dimensional gait data were used to identify gait impairments by the multidisciplinary clinical team. Gait patterns were classified using the plantarflexor-knee extension couple index and the Gait Profile Score (GPS). The reason for referral and the recommendations made post-3DGA were collated in decision trees to extrapolate the potential value of 3DGA in decision making for targeted intervention in this population. Result(s): Participants with SCD generally walked at a reduced gait speed. When grouped by neurological level, the tetraplegia group had a significantly lower GPS, but no specific gait patterns emerged. Participants were primarily referred to the CGAS to direct clinical intervention decisions. The most frequent recommendation following 3DGA was the prescription of an ankle foot orthosis and in some cases, the recommendation was incongruent with the referrer's proposed intervention. Significance: 3DGA can provide specific guidance in management plans for gait of patients with incomplete SCD and may help to avoid inappropriate or unnecessary interventions. This sample of patients referred to the CGAS demonstrates its clinical utility in guiding clinicians in their decision making to target individualised intervention.Copyright © 2019 Elsevier B.V.

Background: There remains a substantial lack of evidence to support the use of foot orthoses as a conservative treatment option for idiopathic toe walking (ITW). Encouraging heel contact during gait is one of the primary goals of most interventions in paediatric ITW. Research Question: Does the combined treatment of high-top boots and orthoses increase the number of heel contacts during gait and change spatio-temporal gait parameters? Methods: This within subject designed randomised controlled trial recruited fifteen children diagnosed with ITW (n = 10 males). They were fitted with bilateral custom made rigid contoured carbon fibre foot orthoses placed inside high-top boots. To analyze the effect of this treatment, heel contacts and spatio-temporal parameters measured by an 8.3 m Gaitrite mat were compared to barefoot walking and shod walking. Result(s): An immediate increase in heel contact (p = 0.021) was observed in the combined treatment only. Gait changes included a large increase in stride time in the combined treatment condition compared to barefoot walking (p = 0.006). This was associated with a decrease in the percentage of swing phase in the gait cycle (p < 0.010), an increase in stance phase (p < 0.010) and an increase in double support time (p < 0.001). Significance: These results suggest the hardness and thickness of the shoe and stiffness of the orthosis midsole may lead to improved local dynamic stability and foot position awareness with increased sensory feedback provided through the entire length of the foot. Further research is indicated to validate this treatment option on long term outcomes in this population group.Copyright © 2018

Introduction: Increased attention to lifespan health-care needs of those with cerebral palsy (CP) has raised awareness of potential mobility changes and falls. Adults with CP may fall frequently, with adverse physical and mental health consequences. Measures of gait speed and gait variability predict falls risk in older adults. The relationship between spatiotemporal gait variables, balance performance and falls history was investigated in ambulant adults with CP. Patients and method: Participants completed a single assessment of gait using instrumented walkway, balance performance testing (Balance Evaluation Systems Test; BESTest), and selfreported falls history. Result(s): Seventeen ambulatory adults with CP, mean age 37 years, participated. Ten participants walked at preferred gait speed of <1.0m/second. Participants demonstrated short stride length and high cadence relative to speed. There was a significant, large positive relationship between preferred gait speed and BESTest total (rho=0.57; p<0.05), and fast gait speed and BESTest total (rho=0.65, p<0.01). There was a significant large negative relationship between double support time at both preferred and fast speeds and BESTest total (preferred: rho=0.061, p<0.05; fast: rho=0.67, p<0.05). Fallers took significantly shorter stride lengths than non-fallers, at preferred (0.56m, 0.85m, p=0.032) and fast gait speeds (0.61m, 0.97m, p=0.025). Comparisons between gait variability and falls history failed to reach significance. Conclusion(s): A falls history was associated with slower gait speed and shorter strides. Future exploration of implications of these features on falls and community access, and potential prognostic value of stride length and gait speed on identifying falls risk in adults with CP is recommended.

Objectives: To support the diagnosis of ASD, one of the key motor features listed in DSM-5 is "odd gait." Despite the growing number of reports, a clear and consistent picture of gait abnormalities in people with ASD has yet to emerge. This study uses full-body, three-dimensional gait analysis to quantify the biomechanics of gait to ascertain how children with ASD walk differently. The purpose of this session is to develop an understanding of how three-dimensional gait data may be used to unravel the complexities associated with the gait disturbance commonly documented in ASD. Method(s): This prospective observational cohort study recruited children (aged 7-12 years) with ASD, Asperger's disorder (AD) (n = 27), high-functioning autism (HFA) (n = 23), and a typically developing (TD) group (n = 24). A three-dimensional motion analysis system recorded full-body joint kinematics as children walked at varied speeds along a 10-meter walkway. To further explore walking ability, a range of conditions with increasing difficulty were then recorded. These conditions included narrowing the walkway, a secondary verbal task, and tandem walk. Key spatial-temporal data, range of movement, and timing of joint range maximums and minimums was extracted and analyzed. Result(s): Children with ASD walked at speeds comparable to TD children, yet showed subtle differences, such as increased vertical center of mass displacement, "bouncy gait," greater forward trunk tilt, and range, and altered timing of ankle motion (all p <= 0.05). Children with AD walked with a stiffer posture with decreased pelvic and lower limb range of movement compared with the HFA group. Specific balance-related deviations in ASD were associated with an increased step width and different double support phases across all conditions. These abnormalities were exacerbated with increasing task complexity. Conclusion(s): The diversity within the ASD population may limit the applicability of joint kinematics in distinguishi

The cerebellum appears to play a key role in the development of internal rules that allow fast, predictive adjustments to novel stimuli. This is crucial for adaptive motor processes, such as those involved in walking, where cerebellar dysfunction has been found to increase variability in gait parameters. Motor adaptation is a process that results in a progressive reduction in errors as movements are adjusted to meet demands, and within the cerebellum, this seems to be localised primarily within the right hemisphere. To examine the role of the right cerebellar hemisphere in adaptive gait, cathodal transcranial direct current stimulation (tDCS) was administered to the right cerebellar hemisphere of 14 healthy adults in a randomised, double-blind, crossover study. Adaptation to a series of distinct spatial and temporal templates was assessed across tDCS condition via a pressure-sensitive gait mat (ProtoKinetics Zeno walkway), on which participants walked with an induced 'limp' at a non-preferred pace. Variability was assessed across key spatial-temporal gait parameters. It was hypothesised that cathodal tDCS to the right cerebellar hemisphere would disrupt adaptation to the templates, reflected in a failure to reduce variability following stimulation. In partial support, adaptation was disrupted following tDCS on one of the four spatial-temporal templates used. However, there was no evidence for general effects on either the spatial or temporal domain. This suggests, under specific conditions, a coupling of spatial and temporal processing in the right cerebellar hemisphere and highlights the potential importance of task complexity in cerebellar function.Copyright © 2016, Springer Science+Business Media New York.

Background. Parkinson disease (PD) is a costly chronic condition in terms of managing both motor and nonmotor symptoms. The burden of disease is high for individuals, caregivers, and the health system. The aim of this study is to estimate the annual cost of PD from the household, health system, and societal perspectives. Methods. A prospective cohort study of newly referred people with PD to a specialist PD clinic in Melbourne, Australia. Participants completed baseline and monthly health resource use questionnaires and Medicare data were collected over 12 months. Results. 87 patients completed the 12-month follow-up assessments. The mean annual cost per person to the health care system was $32,556 AUD. The burden to society was an additional $45,000 per annum per person with PD. The largest component of health system costs were for hospitalisation (69% of total costs). The costs for people with moderate to severe disease were almost 4 times those with mild PD ($63,569 versus $17,537 p<0.001). Conclusion. PD is associated with significant costs to individuals and to society. Costs escalated with disease severity suggesting that the burden to society is likely to grow with the increasing disease prevalence that is associated with population ageing.Copyright © 2017 Shalika Bohingamu Mudiyanselage et al.

This study aimed to determine the impact of multiple doses of whole-body vibration on heel strike, spatial and temporal gait parameters, and ankle range of motion of children with idiopathic toe walking. Whole-body vibration was applied for 5 sets of 1 minute vibration/1 minute rest. Gait measures were collected pre intervention, 1, 5, 10, and 20 minutes postintervention with the GaitRite electronic walkway. Ankle range of motion was measured preintervention, immediately postintervention, and 20 minutes postintervention. The mean (SD) age of the 15 children (n = 10 males) was 5.93 (1.83) years. An immediate increase in heel contact (P =.041) and ankle range of motion (P =.001 and P =.016) was observed. These changes were unsustained 20 minutes postvibration (P >.05). The gait improvement from whole-body vibration could potentially be due to a rapid increase in ankle range of motion or a neuromodulation response.Copyright © The Author(s) 2016.

Footwear has been implicated as a factor in falls, which is a major issue affecting the health of older adults. This study investigated the effect of footwear with dorsal fixation, slippers and bare feet on minimum foot clearance, heel slippage and spatiotemporal variables of gait in community dwelling older women. Thirty women participated (mean age (SD) 69.1 (5.1) years) in a gait assessment using the GaitRITE and Vicon 612 motion analysis system. Conditions included footwear with dorsal fixation, slippers or bare feet. Footwear with dorsal fixation resulted in improved minimum foot clearance compared to the slippers and bare feet conditions and less heel slippage than slippers and an increase in double support. These features lend weight to the argument that older women should be supported to make footwear choices with optimal fitting features including dorsal fixation. Recommendations of particular styles and features of footwear may assist during falls prevention education to reduce the incidence of foot trips and falls.Copyright © 2015 Elsevier B.V.

Footwear has been implicated as a factor in falls, which is a major issue affecting the health of older adults. This study investigated the effect of footwear with dorsal fixation, slippers and bare feet on minimum foot clearance, heel slippage and spatiotemporal variables of gait in community dwelling older women. Thirty women participated (mean age (SD) 69.1 (5.1) years) in a gait assessment using the GaitRITE and Vicon 612 motion analysis system. Conditions included footwear with dorsal fixation, slippers or bare feet. Footwear with dorsal fixation resulted in improved minimum foot clearance compared to the slippers and bare feet conditions and less heel slippage than slippers and an increase in double support. These features lend weight to the argument that older women should be supported to make footwear choices with optimal fitting features including dorsal fixation. Recommendations of particular styles and features of footwear may assist during falls prevention education to reduce the incidence of foot trips and falls.

Background. Falls are common and disabling in people with Parkinson's disease (PD). There is a need to quantify the effects of movement rehabilitation on falls in PD. Objective. To evaluate 2 physical therapy interventions in reducing falls in PD. Methods. We randomized 210 people with PD to 3 groups: progressive resistance strength training coupled with falls prevention education, movement strategy training combined with falls prevention education, and life-skills information (control). All received 8 weeks of out-patient therapy once per week and a structured home program. The primary end point was the falls rate, recorded prospectively over a 12 month period, starting from the completion of the intervention. Secondary outcomes were walking speed, disability, and quality of life. Results. A total of 1547 falls were reported for the trial. The falls rate was higher in the control group compared with the groups that received strength training or strategy training. There were 193 falls for the progressive resistance strength training group, 441 for the movement strategy group and 913 for the control group. The strength training group had 84.9% fewer falls than controls (incidence rate ratio [IRR] = 0.151, 95% CI 0.071-0.322, P <.001). The movement strategy training group had 61.5% fewer falls than controls (IRR = 0.385, 95% CI 0.184-0.808, P =.012). Disability scores improved in the intervention groups following therapy while deteriorating in the control group. Conclusions. Rehabilitation combining falls prevention education with strength training or movement strategy training reduces the rate of falls in people with mild to moderately severe PD and is feasible.Copyright © 2015 American Society of Neurorehabilitation.

Background: Falls are common in idiopathic Parkinson's disease (PD) and frequently occur when walking and crossing obstacles. Objective(s): To determine whether people with mild to moderately severe PD have abnormal centre of mass (CoM) motion in response to the perturbations of level-ground walking and obstacle crossing. Method(s): Mediolateral excursion and velocity of the CoM were measured using three-dimensional motion analysis and force platforms in 20 people with mild to moderately severe PD at the peak dose of their PD medication, and 20 age and sex matched healthy control participants. Result(s): People with PD had greater sideways sway than healthy older adults when walking, particularly when walking over obstacles. People with PD also maintained their CoM more medial to their stance foot throughout the swing phase of gait compared to controls. The severity of motor symptoms in people with PD, measured using the UPDRS-III, was associated with faster sideways CoM motion but not increased CoM excursions. Conclusion(s): Environmental hazards, such as ground-based obstacles, may accentuate postural instability in people with PD. Increased mediolateral sway might be due to impaired postural responses or kinematic compensations to increase foot clearance. Fall prevention programs could benefit from inclusion of components educating people with PD about the risks associated with obstacle crossing when walking. © 2013 Elsevier B.V.

Background Falls are common in idiopathic Parkinson's disease (PD) and frequently occur when walking and crossing obstacles. Objective To determine whether people with mild to moderately severe PD have abnormal centre of mass (CoM) motion in response to the perturbations of level-ground walking and obstacle crossing. Method Mediolateral excursion and velocity of the CoM were measured using three-dimensional motion analysis and force platforms in 20 people with mild to moderately severe PD at the peak dose of their PD medication, and 20 age and sex matched healthy control participants. Results People with PD had greater sideways sway than healthy older adults when walking, particularly when walking over obstacles. People with PD also maintained their CoM more medial to their stance foot throughout the swing phase of gait compared to controls. The severity of motor symptoms in people with PD, measured using the UPDRS-III, was associated with faster sideways CoM motion but not increased CoM excursions. Conclusions Environmental hazards, such as ground-based obstacles, may accentuate postural instability in people with PD. Increased mediolateral sway might be due to impaired postural responses or kinematic compensations to increase foot clearance. Fall prevention programs could benefit from inclusion of components educating people with PD about the risks associated with obstacle crossing when walking.

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. Method(s): 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. Result(s): 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 < .001). Conclusion(s): 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. © 2012 Kelly et al.; licensee BioMed Central Ltd.

This systematic review and critical evaluation of the literature investigates whether advanced age compromises obstacle crossing for unconstrained and time-constrained conditions. Eight electronic databases were searched for articles with terms relating to obstacle crossing during walking in their title, abstract or keywords. 15 articles were reviewed from an initial yield of 727 articles. The methodological quality of each article was critiqued and data extracted by two reviewers. Young and older adults were shown to contact obstacles infrequently when adequate time was available to adapt foot placement in relation to the obstacle. When less time was available to adjust the foot trajectory, older adults contacted obstacles more often than younger people. Older adults adopted a slower, more conservative obstacle crossing strategy. They demonstrated greater hip flexion during the swing phase of gait for the lead and trail limbs as well as greater hip flexion, hip adduction and ankle dorsiflexion during the stance phase for the lead and trail limbs. There was also evidence of reduced internal moments across the hip and ankle during key events in the obstacle crossing gait cycle in older adults. Despite using a more conservative obstacle crossing strategy, older adults are at greater risk of contacting obstacles for time-constrained conditions. © 2009 Elsevier B.V. All rights reserved.

Both efficacy and clinical feasibility deserve consideration in translation of research outcomes. This study evaluated the feasibility of rehabilitation programs within the context of a large randomized controlled trial of physical therapy. Ambulant participants with Parkinson's disease (PD) (n = 210) were randomized into three groups: (1) progressive strength training (PST); (2) movement strategy training (MST); or (3) control (life skills). PST and MST included fall prevention education. Feasibility was evaluated in terms of safety, retention, adherence, and compliance measures. Time to first fall during the intervention phase did not differ across groups, and adverse effects were minimal. Retention was high; only eight participants withdrew during or after the intervention phase. Strong adherence (attendance > 80 %) did not differ between groups (P =.435). Compliance in the therapy groups was high. All three programs proved feasible, suggesting they may be safely implemented for people with PD in community-based clinical practice. © 2012 Jennifer L. McGinley et al.

This study investigates the effects of Parkinson's disease (PD) on foot trajectories and spatiotemporal gait adaptations when approaching and stepping over a ground-based obstacle. Twenty people with mild-moderate PD and 20 age and sex matched controls walked 10 steps at their preferred speed along a walkway and stepped over an obstacle (height 10% of leg length x 600 mm x 10 mm). Control participants also performed trials at the same speed and step length as their matched PD participant. People with PD approached and stepped over the obstacle slower and with smaller steps, but had a similar foot clearance. Those with PD were also more likely to step on the obstacle because they did not place their foot close enough to the front of the obstacle before crossing it to accommodate for their reduced step length. During the lead limb crossing step, people with PD increased their step width, whereas controls maintained a narrow step width. These findings indicate that people with PD have difficulty lengthening their step over the obstacle rather than increasing foot height. Increasing step width is a possible compensation strategy used to overcome postural instability during obstacle crossing in those with PD. © 2009 Elsevier B.V.

Background: Falls are very common in people with Parkinson Disease (PD). The experience of slips, trips and falls is one factor which influences people to restrict their activity. Falls in the community (outside the home environs) may cause people to restrict their community activity, contributing to isolation and reduced quality of life. Little is known about how many people with PD experience community falls and what factors contribute to these falls. Aim(s): This study aimed to investigate the personal and environmental characteristics associated with community falls in people with PD. Method(s): 100 people with idiopathic PD who were able to walk independently and were not cognitively impaired were included in the study. Number and circumstances of the first fall reported over a 12 month period were collected using a falls diary and hotline. Baseline characteristics of age, disease duration, 12 month fall history, and scores from the Unified Parkinson Disease Rating Scale, Hoehn and Yahr, and MMSE were used to compare personal characteristics of community vs. non community fallers. Environmental characteristics associated with falls were classified using the framework provided by the Environmental Aspects of Mobility Questionnaire. Result(s): Fifty-seven people (57%) reported 1032 falls in the 12 month period. Of those who fell, 9 (16%) reported that their first fall occurred in the community, and were classified as community fallers. While no significant differences were detected in personal characteristics of the community fallers compared to non community fallers, there was a trend (p=0.056) for community fallers to report fewer falls in the 12 month follow up (4.9) compared to the non community fallers (9.7). Falls that occurred in the community were more likely to result in injury than non community falls (55.6% vs. 32.3%; p<0.001). Community falls occurred more frequently outdoors than non community falls (44.4% vs. 22.6%) and were more commonly attributed

Background: Freezing of gait (FOG), a feature of Parkinson's disease (PD), increases with disease progression. The incidence of FOG remains unclear especially in the early stages of the disease. Aim(s): (1) To characterize FOG in people with PD who live in the community; and (2) to investigate the relationship between the frequency and severity of FOG with duration and severity of disease. Method(s): 210 community dwelling people with PD, stages 1 to 4 Hoehn and Yahr (H&Y), with a MMSE score of 24 or greater and the ability to participate in exercise programs were included in a RCT investigating the effect of exercise on mobility and falls. Baseline data from the freezing of gait questionnaire (FOG-Q) [1], the H&Y scale and disease duration were used in this study. Descriptive statistics characterized the FOG episodes and Spearman's correlation coefficient was used to examine the relationship between FOG frequency (question 3 of the FOG-Q) and FOG severity or duration of FOG episodes (question 4 of the FOG-Q) with both duration (years since diagnosis at time of testing) and severity of disease (H&Ystage). Result(s): 28% of the 54 people who had PD for 2 or less years reported freezing of gait. The number of people who reported FOG was greatest in those who had a longer duration of disease, with 84 % of the 38 people who had PD for > 10 years experiencing freezing. The number of people reporting freezing episodes increased across the H&Y stages, with only 31% of people at H&Ystage 1 or 2 reporting FOG, compared to 79% of people with H&Y of 4. Of the 107 participants who reported freezing, 89% experienced FOG at step initiation and 73% on turning. There was a significant relationship between the frequency of FOG and both disease duration (rs=.42, p<.001) and disease severity (rs=.43, p<.001). Severity of FOG was significantly correlated with PD duration (rs=.46, p<.001) and disease severity (rs=0.44, p<.001). Conclusion(s): Even though FOG was associated with disease

Background: Freezing of gait (FOG) is a gait disorder that causes significant functional difficulty to people with Parkinson's disease (PD). Prior evidence suggests that FOG is associated with an increased risk of falls, increased fear of falling and reduced quality of life. Aim(s): The aim of the study was to compare the clinical profile differences in a community dwelling sample of people with Parkinson's disease (PD) who experience freezing (FOG) compared to those who do not (NoFOG). Method(s): 210 community dwelling people with PD in Melbourne, Australia were recruited as a sample of convenience into a large randomised trial of physiotherapy intervention to reduce falls. To be included, participants were able to walk, Hoehn and Yahr (HY) <5, with an MMSE of >24 and no other neurological disorders affecting gait. The presence of FOG was defined by a score of > 0 on Item 3 of the Freezing of Gait Questionnaire (FOG-Q) [1]. Fear of falling was assessed with the Falls Efficacy Scale-International (FES-I) [2] and quality of life assessed with the PDQ-39. Result(s): Participants who experienced FOG comprised 52% of the sample. There was no difference in the mean age of the groups (67 years in both), although the FOG group had a significantly longer disease duration:-FOG; 8.25 years (SD: 6.1), NoFOG; 5.1 years (SD: 4.6), and more severe disease (median HY stage FOG; 3, NoFOG; 2). The FOG group had a higher frequency of people who reported prior falls, and were markedly more concerned about falling than the NoFOG group, with total FES-I scores of 31.4 (SD; 10.7) and 23.3 (SD; 7.6) respectively (p <.001). Fear of falling was moderately correlated with both the total FOG-Q score (rs =.60, p <.001) and PDQ-SI (rs =.60, p <.001). Overall QOL was also lower in the FOG group (p <.001), reflecting the influence of significant differences in the mobility, activities of daily living, and communication domains. Discussion/Conclusion: Freezing of gait occurs commonly in people wit

Background: People with Parkinson disease (PD) have a typical onset age after 60. There is however, a small group of people who present with PD age 50 or prior. The limited available evidence suggests PD has greater impact on younger individuals, with lower quality of life, loss of employment, and higher incidence of depression. Aim(s): To compare the clinical and demographic profile of a young-onset PD (YO-PD; diagnosed <=50 years) group compared to a disease-duration matched group with older-onset PD (OO-PD). Method(s): 210 community-dwelling people with PD were recruited as a sample of convenience for a randomised controlled trial. From sample at baseline, 16 YO-PD participants were matched by gender and disease duration to 16 OO-PD participants to identify differences unrelated to PD duration. Assessment included social and demographic data, Hoehn and Yahr score, Part II and III of the Unified Parkinson Disease Rating Scale (UPDRS), Quality of life (QOL) via PDQ-39 and dyskinesia by the modified Dyskinesia Rating Scale. Result(s): Both groups comprised 9 males and 7 females. Age of diagnosis differed; with mean onset in YO-PD group at 43.5(SD;5.3) years and 71.6(8.5) in the OO-PD group. Age at assessment was 50.0(4.4) and 78.4(6.4) years respectively. Years of disease duration did not differ; with 6.7(3.4) in YO-PD and 6.8(3.6) in OO-PD. The YO-PD group had less severe disease, with a median HY of 2, compared to 3 in OO-PD. Part III of the UPDRS (motor) differed, with scores of 13.1(5.2) in YO-PD group and 17.5(5.4) in OO-PD group. Part II (ADL) did not differ between groups. OO-PD participants had more co-morbidities, like arthritis or hypertension. Almost all participants were on levodopa medication (94%). Of this, a higher number of YO-PD group (81%) were on >= 2 anti-PD drugs compared to the OO-PD group (56%). Dyskinesia was present in more of the YO-PD (31%) than the OO-PD group (19%). Of the 9 YO-PD people (56%) in employment, all reported reducing work ho

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(s): 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.

Background: Parkinson's disease (PD) is a progressive neurological condition that mainly affects older people and, over the course of the disease can be disabling. Although gait disorders such as hypokinesia are a feature of PD, the extent to which hypokinesia is associated with disability remains poorly understood. Objective(s): This study investigates the relationships between gait hypokinesia and disability in Australian adults living with PD. Method(s): A retrospective, cross-sectional design that utilized baseline data from an ongoing rehabilitation trial. Community-ambulant adults with PD without dementia were recruited. Gait hypokinesia was quantified using the Timed Up and Go (TUG) and the 6 metre walk test. Disability was measured using the Unified PD rating scale (UPDRS). Analyses focused on Parts II (activities of daily living) and III (motor examination) of the UPDRS. Result(s): 210 adults with PD (mean age 70 +/- 9.6 years, mean PD duration 6.7 +/- 5.6 years, median Hoehn and Yahr stage 2.5) were tested. The mean gait speed was 1.2 +/- 0.3 m/s, the mean TUG scores were 10.6 +/- 4s and the mean total UPDRS scores were 32.3 +/- 13.1. Gait speed was moderately correlated with UPDRS Part II (rho=-0.4, p < 0.001) and UPDRS Part III (rho=-0.6, p< 0.001). Likewise, TUG scores correlated moderately strongly with UPDRS Part II (rho=0.4, p <0.001) and UPDRS Part III (rho=0.5, p<0.001). Walking cadence was not associated with ADL performance although it was related to parkinsonian impairments and mobility (rho=-0.2, p <0.001). Discussion and Conclusion(s): More severe gait hypokinesia was associated with more severe disability. Gait hypokinesia, in particular gait speed during walking and turning, is related to the level of disability in people with PD. The TUG and 6 metre walk tests appear to be useful tools to measure the impact of gait impairments on disability.

This study investigates the effects of Parkinson’s disease (PD) on foot trajectories and spatiotemporal gait adaptations when approaching and stepping over a ground-based obstacle. Twenty people with mild-moderate PD and 20 age and sex matched controls walked 10 steps at their preferred speed along a walkway and stepped over an obstacle (height 10% of leg length × 600 mm × 10 mm). Control participants also performed trials at the same speed and step length as their matched PD participant. People with PD approached and stepped over the obstacle slower and with smaller steps, but had a similar foot clearance. Those with PD were also more likely to step on the obstacle because they did not place their foot close enough to the front of the obstacle before crossing it to accommodate for their reduced step length. During the lead limb crossing step, people with PD increased their step width, whereas controls maintained a narrow step width. These findings indicate that people with PD have difficulty lengthening their step over the obstacle rather than increasing foot height. Increasing step width is a possible compensation strategy used to overcome postural instability during obstacle crossing in those with PD.

This systematic review and critical evaluation of the literature investigates whether advanced age compromises obstacle crossing for unconstrained and time-constrained conditions. Eight electronic databases were searched for articles with terms relating to obstacle crossing during walking in their title, abstract or keywords. 15 articles were reviewed from an initial yield of 727 articles. The methodological quality of each article was critiqued and data extracted by two reviewers. Young and older adults were shown to contact obstacles infrequently when adequate time was available to adapt foot placement in relation to the obstacle. When less time was available to adjust the foot trajectory, older adults contacted obstacles more often than younger people. Older adults adopted a slower, more conservative obstacle crossing strategy. They demonstrated greater hip flexion during the swing phase of gait for the lead and trail limbs as well as greater hip flexion, hip adduction and ankle dorsiflexion during the stance phase for the lead and trail limbs. There was also evidence of reduced internal moments across the hip and ankle during key events in the obstacle crossing gait cycle in older adults. Despite using a more conservative obstacle crossing strategy, older adults are at greater risk of contacting obstacles for time-constrained conditions.

Background. Cost of illness studies show that Parkinson disease (PD) is costly for individuals, the healthcare system and society. The costs of PD include both direct and indirect costs associated with falls and related injuries. Methods. This protocol describes a prospective economic analysis conducted alongside a randomised controlled trial (RCT). It evaluates whether physical therapy is more cost effective than usual care from the perspective of the health care system. Cost effectiveness will be evaluated using a three-way comparison of the cost per fall averted and the cost per quality adjusted life year saved across two physical therapy interventions and a control group. Conclusion. This study has the potential to determine whether targetted physical therapy as an adjunct to standard care can be cost effective in reducing falls in people with PD. Trial Registration. No: ACTRN12606000344594. © 2008 Watts et al; licensee BioMed Central Ltd.