This is a single-blind, randomized, and controlled trial of an innovative approach to fall prevention in individuals with Parkinson's disease. We hypothesize that gait and step perturbation (GSP) will increase gait speed, cadence, stride length, dynamic balance, and reduce fall frequency and Gait and Balance Scores compared to a group who receives seated exercise (SPT). Inclusion criteria: 1) diagnosis of PD;2) postural instability- gait disorder predominant PD;3) history of falls, gait freezing or a positive pull test;4) stable regimen of medications;5) ability to stand and walk 3-m without assistance;6) stage 2 or 3 of the Hoehn and Yahr disability scale;and 7) moderate or higher cognitive score. Ninety subjects will be randomly assigned to 1) GSP;or 2) SPT. GSP will receive gait training on a treadmill and in a safety harness while walking in 4 directions: frontwards, backwards, left sideways and right sideways. Training will start with a treadmill speed that is equivalent to fastest overground walking speed for forward walking, and fastest possible for other directions, and will increase during training. The GSP group will also receive step training while positioned in 4 directions consisting of suddenly turning the treadmill on /off. The subjects will be required to maintain their balance during perturbations. The SPT group will receive seated active range of motion, and upper and lower extremity aerobic training. The interventions will occur 1 hour/day, 3 times per week for 8 weeks. Tests will include usual and fastest gait speed, 5-step test, Unified Parkinson's Disease Rating Scale, Gait and Balance Scale, Center for Epidemiological Studies-Depression Scale, Cognistat, a co-morbidity scale, Activities Balance Confidence, Physical Activity Scale for the Elderly, and limits of stability. Planned comparisons will be made on the temporal and spatial parameters of gait (on and off medications), and dynamic balance (5-step test) {on and off medications} before and after an 8-week period and during 1- &5- month follow ups. Fall frequencies will be established for 5 months prior to and 5 months after the interventions.

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Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Musculoskeletal Rehabilitation Sciences Study Section (MRS)
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Shinowara, Nancy
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University of Texas Medical Br Galveston
Other Health Professions
Schools of Allied Health Profes
United States
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Bryant, M S; Rintala, D H; Hou, J G et al. (2016) Gait variability in Parkinson's disease: levodopa and walking direction. Acta Neurol Scand 134:83-6
Bryant, Mon S; Hou, Jyhgong Gabriel; Collins, Robert L et al. (2016) Contribution of Axial Motor Impairment to Physical Inactivity in Parkinson Disease. Am J Phys Med Rehabil 95:348-54
Bryant, Mon S; Rintala, Diana H; Hou, Jyh-Gong et al. (2015) Relationship of falls and fear of falling to activity limitations and physical inactivity in Parkinson's disease. J Aging Phys Act 23:187-93
Bryant, Mon S; Rintala, Diana H; Graham, James E et al. (2014) Determinants of use of a walking device in persons with Parkinson's disease. Arch Phys Med Rehabil 95:1940-5
Bryant, Mon S; Rintala, Diana H; Hou, Jyh-Gong et al. (2014) Influence of fear of falling on gait and balance in Parkinson's disease. Disabil Rehabil 36:744-8
Bryant, Mon S; Rintala, Diana H; Hou, Jyh-Gong et al. (2013) Reliability of the non-instrumented walk test in persons with Parkinson's disease. Disabil Rehabil 35:538-42
Bryant, M S; Rintala, D H; Hou, J G et al. (2012) The relation of falls to fatigue, depression and daytime sleepiness in Parkinson's disease. Eur Neurol 67:326-30
Bryant, Mon S; Rintala, Diana H; Hou, Jyhgong G et al. (2011) Gait variability in Parkinson's disease: influence of walking speed and dopaminergic treatment. Neurol Res 33:959-64
Bryant, M S; Rintala, D H; Hou, J G et al. (2011) Effects of levodopa on forward and backward gait patterns in persons with Parkinson's disease. NeuroRehabilitation 29:247-52
Bryant, Mon S; Rintala, Diana H; Lai, Eugene C et al. (2009) Evaluation of a new device to prevent falls in persons with Parkinson's disease. Disabil Rehabil Assist Technol 4:357-63

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