Change in Montreal Cognitive Assessment (MoCA)
The MoCA will be used to evaluate general cognitive function of the participants. It evaluates several cognitive functions including attention, set-shifting, short-term memory, verbal fluency, calculation, orientation, digit span, conceptual thinking, and visuospatial processing skills. The total score of MoCA is 30 with a higher score indicating better cognitive function. The MoCA has good to excellent psychometric properties. MoCA will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in the Stroop Color-Word test
The Stroop Color-Word test will be used to evaluate the changes in executive functions in people with PD. The executive functions involved in the Stroop Color-Word test are selective attention, inhibition, and set-shifting. The Stroop Color-Word test comprises the congruent and incongruent testing conditions. The congruent condition is when the color ink of a word is coherent with the written color name, and the incongruent condition is when the color ink differs from the written color name (e.g., the word 'red' written in blue ink). The participants are instructed to read out the ink color of the word, but not the color word name, as accurately and as fast as possible within 45 seconds. The Stroop Color-Word test will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in the Unified Parkinson's Disease Rating Scale (UPDRS)
The Unified Parkinson's Disease Rating Scale (UPDRS) is a well-established and widely used rating tool for the evaluation of disease severity of PD. This study will only evaluate Part 3 of the scale - the motor disturbances of the patients. The total score ranges from 0 to 132 for Part 3 of the UPDRS with a lower score indicates less PD symptoms and a higher score suggests more severe in PD disease. Internal consistency and validity has been established to be excellent for UPDRS. UPDRS will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in fatigue severity questionnaire (FSS)
The FSS will be used to determine how fatigue interferes an individual's daily living and social participation. It contains 9 items, and each item is scored on a 7-point scale with a score 1 indicates strongly disagree and score 7 indicates strongly agree. The total score ranges from 9 to 63, with a higher score indicate greater fatigue severity. FSS will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in Activities-Specific Balance Confidence (ABC) Scale
The Activities-Specific Balance Confidence (ABC) scale will be used to examine an individual's confidence level of not falling when performing activities of daily living. The ABC Scale contains 16 different activities performed indoors and outdoors. The participants will be asked to rate their confidence level (range from 0% to 100% of confidence) of not falling for each item. An average score of the 16 items (range from 0% to 100%) will be calculated to determine the participant's confidence level of not falling when performing the activities of daily living. The internal consistency and test-retest reliability of the ABC scale in patients with PD were excellent. The ABC scale will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in Parkinson's Disease Questionnaire-39 (PDQ-39)
The PDQ-39 is a self-report questionnaire containing 39 items assessing the impact of PD on quality of life. The PDQ-39 covers 8 dimensions: mobility, activities of daily living, emotional well-being, stigma, cognition, communication, and bodily discomfort. The participants are required to answer the questions based on their experiences in the preceding month prior to the interview. The scoring system for each item ranges from 0 (never have difficulty) to 4 (always have difficulty) with lower scores suggesting better quality of life. PDQ-39 will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in New Freezing of Gait Questionnaire (NFOG-Q)
The NFOG-Q will be used to evaluate the freezing frequency and severity of the patients with PD. It composes of 3 parts; in the first part, a video clip will be shown to the participants with PD and help to classify whether an individual is a freezer or non-freezer. The second and third part of the questionnaire is designed for freezers only. PartⅡassesses the severity of FoG according to the frequency and duration of the freezing episodes, while PartⅢevaluates the impact of freezing on daily activities, such as walking. The reliability and internal consistency of the NFOG-Q have been well-established for patients with PD. NFOG-Q will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in Geriatric Depression Scale (GDS)
The GDS is a self-report measure of depression in older adults. The GDS contains 15 items, and the users respond in a "Yes/No" format to each question in reference to the past 1 week. GDS will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in The Timed Up and Go (TUG) Test
The participants will initially sit on a comfortable chair with hips and knees flexed at 90°. Upon a 'GO' signal, the participants will stand up from the chair, walk for 3 meters, turn around, walk back to the chair, and sit down. The participants will be instructed to complete the task at their preferred/ comfortable speed. Good to excellent test-retest reliability and inter-rater reliability have been established in people with PD. TUG will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in Five Times Sit-to-Stand (FTSTS) Test
The FTSTS test will be evaluated to represent the strength and endurance of the lower limbs. The participants will be sat on a standardized chair, and they will be required to stand up and then sit down for 5 times as fast as possible. The amount of time the participants need to complete the task will be recorded, and a lesser amount of times would indicate better strength of the lower extremities. FTSTS will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in motor evoked potential (MEP)
Transcranial magnetic stimulation (TMS) will be used to evaluate the MEP. Peak-to-peak MEP amplitude is an indicator of the integrity and excitability of the corticospinal tract. MEP will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in cortical silent period (CSP)
Transcranial magnetic stimulation (TMS) will be used to evaluate the CSP. The CSP is a period when EMG activity being suppressed for a few hundred milliseconds after the MEP, and has often been used as an indicator of the inhibitory mechanism occurs within the corticospinal tract. CSP will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in intracortical inhibition and facilitation
Paired pulse TMS will be used to evaluate the intracortical inhibition and facilitation. Intracortical inhibition and facilitation will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in muscle strength of lower extremity muscles
Hand-held dynamometer will be used to measure changes in muscle strength. The muscle groups in interest are hip flexors and extensors, knee flexors and extensors, and ankle dorsiflexors. Measurement of each muscle group will be repeated 3 times and an average score will be recorded. Muscle strength will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.
Change in six-minute walk test (6MWT)
The 6MWT will be used to measure the muscle endurance and cardiopulmonary function of the participants. The participants will be required to walk back and forth along a 30-meter walkway continuously for 6 minutes. Participants will be instructed to walk as far as possible within the 6 minutes. If they are too tired to continue walking, they will be allowed to rest as needed but resume walking as soon as possible. Total distance that the participants walk will be recorded. Additionally, heart rate and RPE will also be recorded immediately after the test. The 6MWT will be assessed at pretest, mid-test, post-test, and follow-up test, and the trend of changes among these time points will be determined.