Mobility in Daily Life and Falls in Parkinson's Disease: Potential for Rehabilitation

The goal of this intervention is to explore the effectiveness of a Turning Intervention (TURN-IT) to improve quality of turning in participants with Parkinson's Disease (PD). An unique exercise program has been developed - TURN-IT - in which participants practice exercises that focus on physiological constraints that impair turning ability, such as axial rigidity, narrow base of support, bradykinesia, and inflexible set-shifting. The 60 participants with PD and a history of falls in the previous 12 months, will be randomized into a 6-week, 3x/week, one-on-one TURN-IT group or No-Intervention Control group. This pilot intervention study will determine the number of subjects needed for a future clinical trial and will determine the sensitivity to change with rehabilitation our daily-life turning quality measures (such as, mean and variability of number of steps to turn, turn amplitude, turn velocity). The investigators predict that the TURN-IT program will improve turning in daily life enough to justify a larger clinical trial.

Investigators involved in measuring outcomes and analyzing the data, will remain blinded to the group that participants are assigned to.

Participants in the treatment group will attend supervised, 1-hour classes, 3 times per week for 6 weeks, one-on-one with the same exercise trainer, overseen by a physical therapist investigator.

Participants in this group will be tested at baseline and 6 weeks later. They will go about their normal daily life during the 6 week period.

Based on the exercise motor learning principles, participants spend 10-15 minutes at each Exercise Station that focuses on particular constraints of turning ability. The stations will focus on important underlying aspects of turning, such as weight-shifting and increasing axial rotation during functional turning tasks. Each station will be progressed across levels to make more challenging (such as adding a dual task). Initially participants will be supported in an overhead body-weight support system (ZeroG) to allow them to practice challenging exercises without the risk of falling.

A 16 item self-administered questionnaire to assess fear of falling. Score range 16-64 with higher score indicating more fear of falling

Question of participant's rating of mobility. Score range from 1-7 with 1-3 indicating improvement, 4 no change, and 5-7 worsening of mobility

A measure of smoothness of turning; the rate of change of acceleration during a turn averaged from daily monitoring

Clinical measure of four balance domains-anticipatory, reactive, sensory, and dynamic gait. Scores range from 0-28 with higher scores indicating worse balance

Question of clinician's rating of participant mobility. Score range from 1-7 with 1-3 indicating improvement, 4 no change, and 5-7 worsening of mobility.

A 39 item self-report questionnaire to assess Parkinson's disease specific health related quality in eight domains of quality of life. Each item scores from 0 (never) to 4 (always). Sub-scale scores and a Parkinson's Disease summary index (PDSI; sum of eight subsections/8) representing the global health-related quality of life will be calculated, with higher scores representing worse quality of life

A clinical scale to assess severity of motor symptoms in Parkinson's disease. Each item is scored 0 (normal) to 4 (severe) with a score range from 0-132

A 16-item self-report scale that participants rate their confidence in performing daily activities. Score range from 0-100% with 0% meaning no confidence and 100% completely confident

The amount of time both feet were on the ground together during straight walking averaged from daily monitoring

The angle between the foot and the ground at heel strike during straight walking averaged from daily monitoring

Coefficient of variation of the angle between the foot and the ground at heel strike during straight walking averaged from daily monitoring

Inclusion Criteria: Diagnosis of idiopathic PD from movement disorders neurologist with the United Kingdom Brain Bank criteria of bradykinesia with 1 or more of the following - rest tremor, rigidity, and balance problems not from visual, vestibular, cerebellar or proprioceptive conditions Responsive to levodopa Hoehn & Yahr stages II-IV Age range 55-85 years old self-report of one or more falls in past 12 months willing and able to attend exercise intervention sessions at OHSU campus, and also refrain from changes in anti-parkinson medications and exercise levels. Exclusion Criteria: Major musculoskeletal or neurological disorders, structural brain disease, epilepsy, acute illness or health history, other than PD no medical condition that precludes exercise MoCA ≤ 21 or inability to follow directions excessive use of alcohol or recreational drugs recent change in medication inability to stand and walk for 2 minutes without an assistive device

Data would be available 6 months after the end of data collection. Data will be stored in our laboratory data repository and so will be available indefinitely.

Data will not be stored on a public website, however researchers may contact us for access to the data. We will send data electronically via a secure server.