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Martha Sajatovic,1,2 Angela L Ridgel,3 Ellen M Walter,1,4 Curtis M Tatsuoka,1,2 Kari Colón-Zimmermann,2 Riane K Ramsey,2 Elisabeth Welter,2 Steven A Gunzler,1,4 Christina M Whitney,1,4 Benjamin L Walter1,4 1Department of Neurology, Case Western Reserve University School of Medicine, 2Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland, 3Department of Exercise Physiology, Kent State University, Kent, 4Movement Disorders Center, University Hospitals Cleveland Medical Center, Cleveland, OH, USA Background: Depression is common in people with Parkinson’s disease (PD), and exercise is known to improve depression and PD. However, lack of motivation and low self-efficacy can make exercise difficult for people with PD and comorbid depression (PD-Dep). A combined group exercise and chronic disease self-management (CDSM) program may improve the likelihood that individuals will engage in exercise and will show a reduction in depression symptoms. The purpose of this study was to compare changes in depression in PD-Dep between individual versus group exercise plus CDSM and to examine participant adherence and perception of the interventions.Methods: Participants (N=30) were randomized to either Enhanced EXerCisE thErapy for PD (EXCEED; group CDSM and exercise) or self-guided CDSM plus exercise. Outcomes were change in depression assessed with the Montgomery–Asberg Depression Rating Scale (MADRS), cognition, apathy, anxiety, sleep, quality of life, motor function, self-efficacy, and patient satisfaction.Results: Both groups showed significant improvement in MADRS (P

Telehealth utilization has increased since the coronavirus disease 2019 pandemic, reducing barriers to healthcare and, potentially, reducing participation in group health-promotion interventions. However, preferences for telehealth versus in-person formats have not been established. To examine preferences for telehealth and in-person format for primary care and group health-promotion interventions among Black and White women and men aged 20-39. We hypothesized that respondents would report a higher preference for telehealth than in-person appointments. This cross-sectional survey study recruited participants to answer questions about access to technology and preferences for telehealth and in-person formats of primary care and group health promotion. Respondents (n = 404) included similar proportions of White women (24.3%, 26.4 ± 4.3 years), Black women (25.0%, 29.0 ± 6.1 years), White men (25.9%, 32.8 ± 4.5 years), and Black men (24.8%, 30.6 ± 5.2 years). About 98.5% reported having a smartphone, and 80.4% had access to a computer with a camera. Preference ratings were higher for in-person visits, compared to telehealth visits, for both primary care (M = 3.86 ± 1.13 vs. M = 2.87 ± 1.18) and group health promotion (M = 3.72 ± 1.12 vs. M = 3.04 ± 1.20) F's(1,400) > 59.0, P's < .001. Most young adults have access to technology, supporting the feasibility of telehealth interventions. However, telehealth preference ratings were lower than in-person appointments. Preferences for delivery formats should be considered when designing behavioral interventions to promote health and prevent disease., (© Society of Behavioral Medicine 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

Background and Purpose: This pilot randomized controlled trial evaluated the effects of 12 sessions of patient-specific adaptive dynamic cycling (PSADC) versus non-adaptive cycling (NA) on motor function and mobility in individuals with Parkinson's disease (PD), using inertial measurement unit (IMU) sensors for objective assessment., Methods: Twenty-three participants with PD (13 in the PSADC group and 10 in the NA group) completed the study over a 4-week period. Motor function was measured using the Kinesia™ sensors and the MDS-UPDRS Motor III, while mobility was assessed with the TUG test using OPAL IMU sensors., Results: The PSADC group showed significant improvements in MDS-UPDRS Motor III scores ( t = 5.165, p < 0.001) and dopamine-sensitive symptoms ( t = 4.629, p = 0.001), whereas the NA group did not improve. Both groups showed non-significant improvements in TUG time. IMU sensors provided continuous, quantitative, and unbiased measurements of motor function and mobility, offering a more precise and objective tracking of improvements over time., Conclusions: PSADC demonstrated enhanced treatment effects on PD motor function compared to NA while also reducing variability in individual responses. The integration of IMU sensors was essential for precise monitoring, supporting the potential of a data-driven, individualized exercise approach to optimize treatment outcomes for individuals with PD.

Background: Previous studies have established that increased Sample Entropy (SampEn) of cadence, a measure of non-linear variability, during dynamic cycling leads to greater improvements in motor function for individuals with Parkinson's disease (PD). However, there is significant variability in responses among individuals with PD due to symptoms and disease progression., Objectives: The aim of this study was to develop and test a paradigm for adapting a cycling exercise intervention using SampEn of cadence and rider effort to improve motor function., Methods: Twenty-two participants were randomized into either patient-specific adaptive dynamic cycling (PSADC) or non-adaptive (NA) group. SampEn of cadence was calculated after each of the 12 sessions, and motor function was evaluated using the Kinesia test. Pearson's correlation coefficient was used to analyze the relationship between SampEn of cadence and motor function improvement. Multiple linear regression (MLR) was used to identify the strongest predictors of motor function improvement., Results: Pearson's correlation coefficient revealed a significant correlation between SampEn of cadence and motor function improvements ( R 2  = -.545, P  = .009), suggesting that higher SampEn of cadence led to greater motor function improvement. MLR demonstrated that SampEn of cadence was the strongest predictor of motor function improvement (β = -8.923, t  = -2.632, P  = .018) over the BMI, Levodopa equivalent daily dose, and effort., Conclusions: The findings show that PSADC paradigm promoted a greater improvement in motor function than NA dynamic cycling. These data will be used to develop a predictive model to optimize motor function improvement after cycling in individuals with PD., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Angela Ridgel and Kenneth Loparo are co-inventors on two patents which are related to the device used in this study: “Bike System for Use in Rehabilitation of a Patient,” US 10,058,736. No royalties have been distributed from this patent.

High-cadence dynamic cycling improves motor symptoms of Parkinson's disease (PD), such as tremor and bradykinesia. However, some participants experience greater benefits than others. To gain insight into how individual characteristics and cycling performance affects functional changes, data from two previous studies were used to build several preliminary predictive models. The purpose was to examine which variables contribute to greater improvement in symptoms after high-cadence dynamic cycling. We hypothesized that individuals with higher body mass index (BMI), increased age, more severe symptoms, and higher PD medication dosages were less likely to contribute effort during cycling. UPDRS-III was assessed before and after each session, and cadence and power were recorded every second. Entropy of cadence was calculated, and data were analyzed using analysis of variance and multiple linear regression. The multiple linear regression model of post UPDRS significantly (R 2 = 0.81, p < 0.001) explained its variance, with pre UPDRS as the main predictor ( p < 0.0001). The binomial logistic model of mean effort did not significantly (R 2 = 0.36, p = 0.14) explain the variance. Post-hoc analysis found a significant (β = 0.28, p = 0.03) moderating effect of different levels of BMI on the association between mean effort and post UPDRS. These results suggest that BMI, effort, and baseline UPDRS levels can potentially predict individual responses to high-cadence dynamic cycling., Competing Interests: AR is a co-inventor on two patents which are related to the device used in this study: “Bike System for Use in Rehabilitation of a Patient,” US 10,058,736 and US 9,802,081. No royalties have been distributed from this patent. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Gates and Ridgel.)

Dance therapy can improve motor skills, balance, posture, and gait in people diagnosed with Parkinson's disease (PD) and healthy older adults (OA). It is not clear how specific movement patterns during dance promote these benefits. The purpose of this cohort study was to identify differences and complexity in dance movement patterns among different dance styles for PD and OA participants in community dance programs using approximate entropy (ApEn) analysis. The hypothesis was that PD participants will show greater ApEn during dance than OA participants and that the unique dance style of tango with more pronounced foot technique and sharp direction changes will show greater ApEn than smoother dance types such as foxtrot and waltz characterized by gradual changes in direction and gliding movement with rise and fall. Individuals participated in one-hour community dance classes. Movement data were captured using porTable 3D motion capture sensors attached to the arms, torso and legs. Classes were also video recorded to assist in analyzing the dance steps. Movement patterns were captured and ApEn was calculated to quantify the complexity of movements. Participants with PD had greater ApEn in right knee flexion during dance movements than left knee flexion ( p = 0.02), greater ApEn of right than left hip flexion ( p = 0.05), and greater left hip rotation than right ( p = 0.03). There was no significant difference in ApEn of body movements ( p > 0.4) or mean body movements ( p > 0.3) at any body-segment in OA. ApEn analysis is valuable for quantifying the degree of control and predictability of dance movements and could be used as another tool to assess the movement control of dancers and aid in the development of dance therapies.

Previous exercise studies in individuals with motor neuron disease have shown some positive benefits but the stress of regular exercise could result in overuse weakness in this population. The purpose of this case study is to determine the efficacy, and tolerability of a high-cadence dynamic cycling intervention in an individual with motor neuron disease. A 67-year-old male with significant lower extremity weakness and a diagnosis of idiopathic motor neuron disease completed six 30-minute sessions of high cadence dynamic cycling over a two-week period using a custom-built motorized ergometer with the motor speed set at 80 revolutions per minute. This intervention resulted in an 80.4 m increase in walking distance during the six-minute walk test (21% increase), with a lower rating of perceived exertion than at baseline. Amyotrophic Lateral Sclerosis Functional Rating Scale-Revised scores improved slightly (2.4%) suggesting that the intervention was tolerated, and it did not compromise the participant's physical function. These data show that this intervention can improve mobility, is well-tolerated and minimizes the risk of overuse weakness in an individual with motor neuron disease.

Introduction: Our objective was to design an eccentric bicycle design to elicit delayed onset muscle soreness (DOMS)., Methods: To assess the bicycle designs' ability to elicit DOMS, fourteen, recreationally active, males performed five-minutes of eccentric bicycling at 50% of their individualized power determined from a modified six-second Wingate test. Outcome measures to assess DOMS included the Likert pain scale, creatine kinase, lactate blood concentration, and pressure algometry detection evaluated at four time points (baseline (before the eccentric bicycling), immediate post, 24 hours post, and 48 hours post)., Results: The Likert pain scale was different (F = 75.88, p < 0.001) at baseline (0.14 ± 0.36) and immediate post (0.21 ± 0.43), compared to 24 hours post (3.07 ± 0.83), and 48 hours post (2.93 ± 1.07). No changes were reported for creatine kinase (F = 0.7167, p = 0.475), lactate blood concentration (F = 2.313, p = 0.107), or pressure algometry detection., Conclusions: To understand mechanisms of DOMS, there is a need for a consistent, reliable method for producing DOMS. Our eccentric bicycle design and protocol offers an alternative approach to previous eccentric ergometer designs - demonstrating the potential to elicit DOMS in one, five-minute session.

The objective was to investigate if high cadence cycling altered non-motor cognition and depression symptoms in individuals with Parkinson's disease (PD) and whether exercise responses were influenced by brain-derived neurotrophic factor (BDNF) Val66Met polymorphism. Individuals with idiopathic PD who were ≥50 years old and free of surgical procedures for PD were recruited. Participants were assigned to either a cycling ( n = 20) or control ( n = 15) group. The cycling group completed three sessions of high cadence cycling on a custom motorized stationary ergometer. The primary outcome was cognition (attention, executive function, and emotion recognition were assessed via WebNeuro ® and global cognition via Montreal Cognitive Assessment). Depression symptoms were assessed via Beck Depression Inventory-II. There was a main effect of time for emotional recognition ( p = 0.048), but there were no other changes in cognition or depression symptoms. Regardless of intervention or Val66Met polymorphism, high cadence cycling does not alter cognition or depression symptoms after three sessions in one week.

Introduction: Exercise has been shown to be an important adjunct therapy to medication in Parkinson's disease (PD). However, the optimal type, frequency, and intensity of exercise or physiotherapy are still being debated. An important part of understanding the optimal frequency is to examine how acute bouts of exercise affect motor function and mobility in this population. The purpose of this study is to assess if six bouts of high-cadence cycling improves motor function and mobility in individuals with PD., Methods: Sixteen subjects with mild-moderate idiopathic PD were randomized into either a high-cadence cycling or a control (stretching) group. High-cadence cycling was completed on a custom motorized recumbent bicycle at a high cadence between 75 and 85 rpm. Cycling and stretching sessions were separated by 1 day of rest and took place over a 15-day period. Motor function and mobility were assessed after every cycling/stretching bout using the UPDRS Motor III scale, Kinesia ONE, and Timed up and Go (TUG)., Results: Six bouts of high-cadence cycling improved UPDRS scores (2.5 pts, P =0.002), hand movement amplitude ( P =0.013), rapid alternating hand movement speed ( P =0.003), gait ( P =0.012), and TUG time (1.17 s, P =0.002) from baseline testing to end of treatment. The control group showed no improvements., Conclusions: These findings suggest that they are both acute and sustained improvements in motor function and mobility after high-cadence cycling. Future research should examine how exercise type, frequency, and intensity can be optimized for each individual.

To assess and validate the Smart Exercise Bike designed for Parkinson's Disease (PD) rehabilitation, 47 individuals with PD were randomly assigned to either the static or dynamic cycling group, and completed three sessions of exercise. Heart rate, cadence and power data were captured and recorded for each patient during exercise. Motor function for each subject was assessed with the UPDRS Motor III test before and after the three exercise sessions to evaluate the effect of exercise on functional abilities. Individuals who completed three sessions of dynamic cycling showed an average of 13.8% improvement in the UPDRS, while individuals in the static cycling group worsened by 1.6% in UPDRS. To distinguish the static and dynamic cycling groups by biomechanical and physiological features, the complexity of the recorded signals (cadence, power, and heart rate) was examined using approximate entropy (ApEn), sample entropy (SaEn) and spectral entropy (SpEn) as measures of variability. A multiple linear regression (MLR) model was used to relate these features to changes in motor function as measured by the UPDRS Motor III scale. Pattern variability in cadence was greater in the dynamic group when compared to the static group. In contrast, variability in power was greater for the static group. UPDRS Motor III scores predicted from the pattern variability data were correlated to measured scores in both groups. These results support our previous study which explained how variability analysis results for biomechanical and physiological parameters of exercise can be used to predict improvements in motor function.

Recent studies in rehabilitation of Parkinson's disease (PD) have shown that cycling on a tandem bike at a high pedaling rate can reduce the symptoms of the disease. In this research, a smart motorized bicycle has been designed and built for assisting Parkinson's patients with exercise to improve motor function. The exercise bike can accurately control the rider's experience at an accelerated pedaling rate while capturing real-time test data. Here, the design and development of the electronics and hardware as well as the software and control algorithms are presented. Two control algorithms have been developed for the bike; one that implements an inertia load (static mode) and one that implements a speed reference (dynamic mode). In static mode the bike operates as a regular exercise bike with programmable resistance (load) that captures and records the required signals such as heart rate, cadence and power. In dynamic mode the bike operates at a user-selected speed (cadence) with programmable variability in speed that has been shown to be essential to achieving the desired motor performance benefits for PD patients. In addition, the flexible and extensible design of the bike permits readily changing the control algorithm and incorporating additional I/O as needed to provide a wide range of riding experiences. Furthermore, the network-enabled controller provides remote access to bike data during a riding session.

Introduction: Studies in animal models of Parkinson's disease (PD) have suggested that the rate of exercise performance is important in treatment efficacy and neuroprotection. In humans with PD, lower-extremity forced-exercise (FE) produced global improvements in motor symptoms based on clinical ratings and biomechanical measures of upper extremity function., Methods: fMRI was used to compare the underlying changes in brain activity in PD patients following the administration of anti-parkinsonian medication and following a session of FE., Results: Nine individuals with PD completed fMRI scans under each condition: off anti-PD medication, on anti-PD medication, and off medication + FE. Unified Parkinson's Disease Rating Motor Scale scores improved by 50% in the FE condition compared to the off-medication condition. The pattern of fMRI activation after FE was similar to that seen with anti-PD medication. Direct comparison of the fMRI activation patterns showed high correlation between FE and anti-PD medication., Conclusion: These findings suggest that medication and FE likely utilize the same pathways to produce symptomatic relief in individuals with PD., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: Exercise can improve motor function in people with Parkinson's disease but depression reduces the motivation to participate in regular exercise. The aim of this study was to develop a novel Enhanced Exercise Therapy program that uses manual-driven guided exercise and peer-facilitated psychoeducation for individuals with Parkinson's disease and depression., Design: 24 week randomized controlled design., Methods: Thirty individuals were randomized to Enhanced Exercise Therapy or self-guided therapy, and evaluated at baseline, 12-weeks and at 24-weeks. Enhanced Exercise Therapy included group exercise and group psychoeducation for 12 weeks. Between 13 and 24 weeks, individuals had access to the fitness facility but group sessions were not held. Self-guided therapy included written guidelines for a self-paced exercise program and psychoeducation. Primary outcome measures included the number of exercise sessions and International Physical Activity Questionnaire score. Secondary measures included resting heart rate, supine blood pressure, estimated VO2max and incidence of orthostatic hypotension., Results: Twenty four individuals completed the study (80% retention) and both groups attended similar number of exercise sessions. There were no significant changes in cardiovascular fitness measures but there was a significant increase in the amount of physical activity in the Enhanced Exercise Therapy group and a decrease in the self-guided therapy group during the post-intervention period., Conclusions: Enhanced Exercise Therapy appears to promote engagement in an exercise program and more physical activity, even after group sessions were concluded in individuals with Parkinson's disease and depression., (Copyright © 2015 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Exposure to hypoxia is associated with cognitive impairment, mediated by cerebral deoxygenation. This can be problematic for individuals who perform mental tasks at high altitude. Eight healthy men completed two experimental trials consisting of 5h of exposure to normobaric hypoxia (12.5% O2). In one of the experimental trials (Hypoxia) subjects remained resting in a seated position the entire 5h; in the other experimental trial (Hypoxia and Exercise) subjects rested 2h, cycled for 1h at constant wattage (workload equivalent to 50% of altitude adjusted VO2max), then rested the last 2h. Cerebral oxygenation was measured continuously via near-infrared spectroscopy and cognitive performance was assessed by Trail Making Test A and B. Cerebral oxygenation and cognitive performance both were impaired during exposure to hypoxia. In the Hypoxia and Exercise trial, subjects experienced further declinations in cerebral oxygenation without concomitant decreases in cognitive function. These data demonstrate that cognitive function declines during exposure to normobaric hypoxia and this decline is not exacerbated by low intensity exercise., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Rationale: Individuals with Parkinson's disease (PD) often have deficits in kinesthesia. There is a need for rehabilitation interventions that improve these kinesthetic deficits. Forced (tandem) cycling at a high cadence improves motor function. However, tandem cycling is difficult to implement in a rehabilitation setting., Objective: To construct an instrumented, motored cycle and to examine if high cadence dynamic cycling promotes improvements in motor function., Method: This motored cycle had two different modes: dynamic and static cycling. In dynamic mode, the motor maintained 75-85 rpm. In static mode, the rider determined the pedaling cadence. UPDRS Motor III and Timed Up and Go (TUG) were used to assess changes in motor function after three cycling sessions., Results: Individuals in the static group showed a lower cadence but a higher power, torque and heart rate than the dynamic group. UPDRS score showed a significant 13.9% improvement in the dynamic group and only a 0.9% improvement in the static group. There was also a 16.5% improvement in TUG time in the dynamic group but only an 8% improvement in the static group., Conclusion: These findings show that dynamic cycling can improve PD motor function and that activation of proprioceptors with a high cadence but variable pattern may be important for motor improvements in PD.

We describe a novel device and method for real-time measurement of lingual-palatal pressure and automatic identification of the oral transfer phase of deglutition. Clinical measurement of the oral transport phase of swallowing is a complicated process requiring either placement of obstructive sensors or sitting within a fluoroscope or articulograph for recording. Existing detection algorithms distinguish oral events with EMG, sound, and pressure signals from the head and neck, but are imprecise and frequently result in false detection. We placed seven pressure sensors on a molded mouthpiece fitting over the upper teeth and hard palate and recorded pressure during a variety of swallow and non-swallow activities. Pressure measures and swallow times from 12 healthy and 7 Parkinson's subjects provided training data for a time-delay artificial neural network to categorize the recordings as swallow or non-swallow events. User-specific neural networks properly categorized 96 % of swallow and non-swallow events, while a generalized population-trained network was able to properly categorize 93 % of swallow and non-swallow events across all recordings. Lingual-palatal pressure signals are sufficient to selectively and specifically recognize the initiation of swallowing in healthy and dysphagic patients.

Background and Aim: With a substantial increase in diagnosed Parkinson's disease, it is of great importance to examine tolerance and physical measures of evolving exercise interventions. Of particular importance, a multifaceted exercise intervention combining active-assisted cycling and resistance training to older adults diagnosed with Parkinson's disease is being assessed., Methods: Fourteen older adults diagnosed with Parkinson's disease and ten healthy older adults (67.5 ± 7.9 years of age) engaged in an 8-week, 24-session, multifaceted exercise protocol. The protocol consisted of both active-assisted cycling and resistance training. Tolerance was measured, as well as multiple indicators of health-related physical fitness. These indicators examined improvements in cardiovascular performance, muscular strength, muscular endurance, and flexibility., Results: Twenty-two older adults and older adults diagnosed with Parkinson's disease tolerated the intervention by completing all 24 sessions. Repeated-measures analysis of variance demonstrated significant (P ≤ 0.003) improvements in cardiovascular performance, muscular strength, muscular endurance, and flexibility for both groups of individuals., Discussion and Conclusion: The multifaceted intervention is the first to combine both active-assisted cycling and resistance training. The older adult and the older adult diagnosed with Parkinson's disease exhibited both tolerance and health-related improvements in physical fitness following the intervention.

Variability in severity and progression of Parkinson's disease symptoms makes it challenging to design therapy interventions that provide maximal benefit. Previous studies showed that forced cycling, at greater pedaling rates, results in greater improvements in motor function than voluntary cycling. The precise mechanism for differences in function following exercise is unknown. We examined the complexity of biomechanical and physiological features of forced and voluntary cycling and correlated these features to improvements in motor function as measured by the Unified Parkinson's Disease Rating Scale (UPDRS). Heart rate, cadence, and power were analyzed using entropy signal processing techniques. Pattern variability in heart rate and power were greater in the voluntary group when compared to forced group. In contrast, variability in cadence was higher during forced cycling. UPDRS Motor III scores predicted from the pattern variability data were highly correlated to measured scores in the forced group. This study shows how time series analysis methods of biomechanical and physiological parameters of exercise can be used to predict improvements in motor function. This knowledge will be important in the development of optimal exercise-based rehabilitation programs for Parkinson's disease.

Background: Parkinson's disease (PD) is a neurological disorder which often results in joint rigidity, bradykinesia and decreased range of motion (ROM). Segmental biomechanical muscle stimulation (BMS) can increase ROM in healthy young adults. However, acute effects on ROM in PD have not been examined., Objective: To examine whether BMS and active-assisted cycling (AAC) of the legs results in acute changes in ROM in PD., Methods: Seventeen individuals with PD completed four sessions. Subjects first came to the lab 'on' PD medications and completed baseline assessments. During session 2, subjects were 'off' PD medications and watched a video describing the interventions. In the 3rd and 4th visits, subjects were 'off' medications and the order of AAC or BMS was counterbalanced. Shoulder and hip ROM was measured prior to and immediately after each intervention and hip kinematics were examined during over-ground walking., Results: There was a significant improvement in hip and shoulder ROM after BMS and AAC. Hip velocity during over-ground walking improved after BMS but not after AAC., Conclusions: Single bouts of BMS and AAC have a positive effect on ROM and hip velocity during over-ground walking. This suggests that BMS and AAC may be altering central motor control processes.

Objectives: To develop a rapid cadence cycling intervention (active-assisted cycling [AAC]) using a motorized bike and to examine physiological perimeters during these sessions in individuals with Parkinson's disease (PD). A secondary goal was to examine whether a single session of AAC at a high cadence would promote improvements in tremor and bradykinesia similar to the on medication state., Design: Before-after pilot trial with cross-over., Setting: University research laboratory., Participants: Individuals with idiopathic PD (N=10, age 45-74y) in Hoehn and Yahr stages 1 to 3., Intervention: Forty minutes of AAC., Main Outcome Measures: Heart rate, pedaling power, and rating of perceived exertion were recorded before, during, and after a bout of AAC. Functional assessments included tremor score during resting, postural, and kinetic tremor., Results: This AAC paradigm was well tolerated by individuals with PD without excessive fatigue, and most participants showed improvements in tremor and bradykinesia immediately after a single bout of cycling., Conclusions: This paradigm could be used to examine changes in motor function in individuals with PD after bouts of high-intensity exercise., (Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Previous studies have shown that single bouts of high-rate active cycling (> 80 rpm) improve upper extremity motor function in individuals with Parkinson's disease (PD). It is unknown if passive leg cycling produces a similar effect on upper extremity function. This article examines whether passive leg cycling can promote immediate changes in upper tremor and bradykinesia in PD and if pedaling rates have variable effects., Methods: Twenty individuals with mild-to-moderate idiopathic PD completed 4 sessions, with each session taking place 1 week apart. In the second to fourth sessions, a motorized bicycle was set to passively rotate the subjects' legs at rates of 60, 70, or 80 rpm for 30 minutes. Quantitative upper extremity motor assessments were completed immediately before and after each session., Results: Passive leg cycling was shown to reduce tremor and bradykinesia in PD. However, the rate of passive cycling did not affect the degree of improvement in bradykinesia or tremor., Conclusion: These findings suggest that lower extremity passive cycling can promote changes in upper extremity motor function in individuals with PD.

Individuals with Parkinson's disease (PD) often experience cognitive declines. Although pharmacologic therapies are helpful in treating motor deficits in PD, they do not appear to be effective for cognitive complications. Acute bouts of moderate aerobic exercise have been shown to improve cognitive function in healthy adults. However, individuals with PD often have difficulty with exercise. This study examined the effects of passive leg cycling on executive function in PD. Executive function was assessed with Trail-Making Test (TMT) A and B before and after passive leg cycling. Significant improvements on the TMT-B test occurred after passive leg cycling. Furthermore, the difference between times to complete the TMT-B and TMT-A significantly decreased from precycling to postcycling. Improved executive function after passive cycling may be a result of increases in cerebral blood flow. These findings suggest that passive exercise could be a concurrent therapy for cognitive decline in PD.

Background: Animal studies indicate forced exercise (FE) improves overall motor function in Parkinsonian rodents. Global improvements in motor function following voluntary exercise (VE) are not widely reported in human Parkinson's disease (PD) patients., Objective: The aim of this study was to compare the effects of VE and FE on PD symptoms, motor function, and bimanual dexterity., Methods: Ten patients with mild to moderate PD were randomly assigned to complete 8 weeks of FE or VE. With the assistance of a trainer, patients in the FE group pedaled at a rate 30% greater than their preferred voluntary rate, whereas patients in the VE group pedaled at their preferred rate. Aerobic intensity for both groups was identical, 60% to 80% of their individualized training heart rate., Results: Aerobic fitness improved for both groups. Following FE, Unified Parkinson's Disease Rating Scale (UPDRS) motor scores improved 35%, whereas patients completing VE did not exhibit any improvement. The control and coordination of grasping forces during the performance of a functional bimanual dexterity task improved significantly for patients in the FE group, whereas no changes in motor performance were observed following VE. Improvements in clinical measures of rigidity and bradykinesia and biomechanical measures of bimanual dexterity were maintained 4 weeks after FE cessation., Conclusions: Aerobic fitness can be improved in PD patients following both VE and FE interventions. However, only FE results in significant improvements in motor function and bimanual dexterity. Biomechanical data indicate that FE leads to a shift in motor control strategy, from feedback to a greater reliance on feedforward processes, which suggests FE may be altering central motor control processes.

The central complex (CC) is a group of midline neuropils in the protocerebrum of all insects (Williams, J Zool, 176:67-86, 1975; Strausfeld, Prog Brain Res, 123:273-284, 1999). Its columnar organization coupled with the anatomical tracts to and from this region suggests that the CC may supervise various forms of locomotion. In cockroach, lesions of the CC affect turning and controlled climbing over blocks (Ridgel et al., J Comp Physiol A, 193:385-402, 2007). Since these behaviors are largely directed by tactile cues detected by antennae, we predicted that some neurons in the CC respond to mechanical antennal stimulation. We used 16-channel probes to record from broad regions within the CC, while mechanically stimulating one or the other antenna. Using cluster cutting procedures, we examined 277 units in 31 preparations. Many of these units responded to mechanical stimulation of the antennae, and of these, most responded equally well to medial or lateral stimulation of either antenna. However, several units either responded to only one antenna or responded significantly more strongly to one of them. Most of the units responding to antennal stimulation were sensitive to changes in the velocity as well as changes in light. Our data reveal a large population of mult-sensory neurons in the CC that could contribute to locomotion control.

Objective: This article describes the effect of a robotic device combined with repetitive-task practice (RTP) on upper-extremity function in a patient with chronic stroke., Method: The client was a 32-year-old woman, 11 months after stroke, with minimal wrist and finger movement. She received approximately 48 hr of intervention split evenly between a robotic device (Hand Mentor) and RTP during 3 weeks., Results: Favorable scores in the Wolf Motor Function Test were observed from pre- to postevaluation. Active range of motion, from pre- to postintervention, increased by 35 degrees in the shoulder, 65 degrees in the wrist, and 70 degrees in the thumb. Kinetic analysis of a bimanual dexterity task indicated improved specification of grasping forces for both limbs., Conclusion: Improvements in upper-extremity motor functioning and functional performance in daily tasks followed this client's engagement in distal initiation of movement during an RTP exercise regimen that was robotically reinforced.

Legged locomotion has evolved as the most effective form of movement through unpredictable and tortuous environments. Upon encountering an obstacle, an animal must evaluate the object with its sense organs then use the information it acquires to direct appropriate transitional behaviors, such as turning. Previous studies using genetic and surgical lesions implicate the central body complex (CBC) in control of such transitional behaviors of various insects. In this study, lesions of the CBC and surrounding brain regions were used to examine the effects of damage on turning in free-moving and tethered cockroaches. Lesions were performed either as sagittal incisions or by inserting small pieces of foil into regions of the brain. Locomotor behaviors of intact and lesioned animals were compared using high speed video and kinematic analysis. The lesions locations were determined through histological methods. Sagittal lesions to the CBC often result in continuous or incorrect turns. Foil lesions in the CBC also increase the probability that individuals will show turning deficits. The location and degree of the lesion had a strong effect on the animal's ability to turn. These data strongly suggest that the CBC mediates the effects of head sense organs that produce changes in the direction of walking.

Few studies in arthropods have documented to what extent local control centers in the thorax can support locomotion in absence of inputs from head ganglia. Posture, walking, and leg motor activity was examined in cockroaches with lesions of neck or circumoesophageal connectives. Early in recovery, cockroaches with neck lesions had hyper-extended postures and did not walk. After recovery, posture was less hyper-extended and animals initiated slow leg movements for multiple cycles. Neck lesioned individuals showed an increase in walking after injection of either octopamine or pilocarpine. The phase of leg movement between segments was reduced in neck lesioned cockroaches from that seen in intact animals, while phases in the same segment remained constant. Neither octopamine nor pilocarpine initiated changes in coordination between segments in neck lesioned individuals. Animals with lesions of the circumoesophageal connectives had postures similar to intact individuals but walked in a tripod gait for extended periods of time. Changes in activity of slow tibial extensor and coxal depressor motor neurons and concomitant changes in leg joint angles were present after the lesions. This suggests that thoracic circuits are sufficient to produce leg movements but coordinated walking with normal motor patterns requires descending input from head ganglia.

Unlike intact animals, cockroaches with bilateral circumoesophageal connective lesions have difficulty climbing up smooth inclines. Typically, they slipped badly or even fell over backward before traveling more than 1.5 body lengths up the incline. The major problem involves increased slippage of the front and sometimes middle legs. Periods of front leg slipping are correlated with excess body elevation that pushes the height of the head to 11 mm above the substrate. Intact animals control body attitude very well on the incline, only rarely rearing above 11 mm. Cockroaches with bilateral circumoesophageal connective lesions spend considerable time above this critical amplitude and slipping increases with amplitude above that value. We conclude that circumoesophageal lesion compromises the insect's ability to control body attitude on the incline and this deficit contributes to the inability of lesioned cockroaches to climb steep inclines. A separate body attitude deficit was noted on steps. Upon climbing to the top of a barrier, intact animals bend their body between the first and second thoracic segments. This action maintains good leg mechanics throughout the climb. Cockroaches with bilateral circumoesophageal connective lesions fail to perform this downward flexion. A beneficial role for similar body flexion in simple robots is described in the Discussion.

Locomotor deficits frequently accompany aging in animals. These deficits are often caused by degeneration in the nervous and musculoskeletal systems. Insects are an excellent model for age-related behavior studies because they are short-lived and have a reduced nervous system with fewer cells than vertebrates. Furthermore, they are highly mobile and display a complex set of locomotor behaviors. This review presents research that has examined age-related locomotor deficits in insects and discusses the value of these studies to understand aging processes in all animals.

Aging is often associated with locomotor deficits. Behavior in aged Blaberus discoidalis cockroaches was analyzed during horizontal walking, climbing, righting and inclined walking. Adult animals showed a decrease in spontaneous locomotion with increasing age. Tarsal abnormalities, termed 'tarsus catch', were often present in aged individuals. In 'tarsus catch', the prothoracic leg catches on the mesothoracic leg during the swing phase. This deficit causes alterations of the gait, but animals are able to regain a tripod gait after the perturbation. The tibio-tarsal joint angle in individuals with 'tarsus catch' was significantly less than in intact animals. Structural defects were consistently associated with 'tarsus catch'. The tracheal tubes in the tarsus and around the tibio-tarsal joint were often discolored and the tarsal pads were hardened in aged cockroaches. All aged individuals were able to climb. However, prior to climbing, some animals with 'tarsus catch' failed to show postural changes that are normally seen in young animals. Aged individuals can right as rapidly as 1-week-old adults. However, animals with 'tarsus catch' take longer to right than aged intact individuals. Old cockroaches have difficulty climbing an incline of 45 degrees, and leg slipping is extensive. Slipping may be caused by tarsal degeneration, but animals that are unsuccessful in inclined walking often show uncoordinated gaits during the attempt. Escape behavior was examined in aged American cockroaches (Periplaneta americana). They do not show normal escape. However, after decapitation, escape movements return, suggesting that degeneration in head ganglia may actually interfere with escape. These findings provide evidence for age-related changes both in the periphery and in the central nervous system of cockroaches and stress the importance of multi-level approaches to the study of locomotion.

All animals generate progressively larger forces as they increase in size and mass. Their abilities to detect these forces must be similarly adjusted. In insects, campaniform sensilla monitor strains in the exoskeleton and provide information about forces acting upon the legs. Each sensory neuron possesses a dendrite that inserts into a cuticular cap in the exoskeleton. The cap is the site of mechanotransduction. We measured the sizes and numbers of receptor caps on the cockroach hindleg at different developmental stages. Our goal was to identify morphological features that could be correlated with the range of forces that must be detected. As cockroaches increase in size through successive molts, the number of cuticular caps in each group increases. The tibial group, for example, has two sensilla in first instar animals and 10-12 in the adult. There is also an increase in the range of cap sizes within each group. Observations of animals and their molted exoskeletons suggest that this increase occurs as the caps of existing receptors increase in size and smaller ones are added with each molt. These changes may be important in increasing the range of forces the receptors can signal while retaining sensitivity to low levels of force.

Responses of the tibial campaniform sensilla, receptors that encode strains in the exoskeleton, were characterized by recording sensory activities during perturbations in freely standing cockroaches. The substrate upon which the animal stood was displaced horizontally using ramp and hold stimuli at varied rates. The sensilla showed short latency responses that were initiated in the first 30 ms of platform movement. Responses of individual receptors depended upon the direction of displacement and the orientation of their cuticular cap. Proximal receptors, whose caps are perpendicular to the long axis of the tibia, responded to displacements directed from the contralateral side of the body and from the head toward the abdomen. The distal sensilla, oriented parallel to the tibia, discharged at longer latency to displacements in opposite directions. Plots of receptor activity versus displacement direction showed that proximal and distal sensilla are activated in non-overlapping ranges of movement direction. Afferent responses also increased as the platform was displaced more rapidly. These results are consistent with a model in which displacements produce forces that result in bending of the tibia. This information could be utilized to detect the direction and rate of forces that occur during leg slipping or in walking on unstable terrains.

Forces exerted by a leg in support and propulsion can vary considerably when animals stand upon or traverse irregular terrains. We characterized the responses of the cockroach tibial campaniform sensilla, mechanoreceptors which encode force via strains produced in the exoskeleton, by applying forces to the leg at controlled magnitudes and rates. We also examined how sensory responses are altered in the presence of different levels of static load. All receptors exhibit phasico-tonic discharges that reflect the level and rate of force application. Our studies show that: (1) tonic discharges of sensilla can signal the level of force, but accurate encoding of static loads may be affected by substantial receptor adaptation and hysteresis; (2) the absolute tonic sensitivities of receptors decrease when incremental forces are applied at different initial load levels; (3) phasic discharges of sensilla accurately encode the rate of force application; and (4) sensitivities to changing rates of force are strictly preserved in the presence of static loads. These findings imply that discharges of the sensilla are particularly tuned to the rate of change of force at all levels of leg loading. This information could be utilized to adapt posture and walking to varying terrains and unexpected perturbations.

A major problem in sensory motor integration is to delineate how forces acting upon a leg are encoded and regulated in the control of posture and locomotion. We have studied responses of the trochanteral campaniform sensilla, the largest array of force detecting mechanoreceptors in the cockroach leg. Afferents from two groups of sensilla (Groups 3 and 4) encode forces applied to the leg in the plane of joint movement of the coxo-trochanteral joint. The receptors within Group 3 exhibit fixed patterns of recruitment that could differentially indicate when force levels are adequate to provide support and propulsion during walking., (Copyright 1999 Published by Elsevier Science B.V.)

The ability to detect changes in load is important for effective use of a leg in posture and locomotion. While a number of limb receptors have been shown to encode increases in load, few afferents have been demonstrated to signal leg unloading, which occurs cyclically during walking and is indicative of slipping or perturbations. We applied mechanical forces to the cockroach leg at controlled rates and recorded activities of the tibial group of campaniform sensilla, mechanoreceptors that encode forces through the strains they produce in the exoskeleton. Discrete responses were elicited from the group to decreasing as well as increasing levels of leg loading. Discharges of individual afferents depended on the direction of force application, and unit responses were correlated morphologically with the orientation of the receptor's cuticular cap. No units responded bidirectionally. Although discharges to decreasing levels of load were phasic, we found that these bursts could effectively encode the rate of force decreases. These discharges may be important in indicating leg unloading in the step cycle during walking and could rapidly signal force decreases during perturbations or loss of ground support.