Подвижность в повседневной жизни и падения при болезни Паркинсона: потенциал для реабилитации

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.

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.

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.

The coefficient of variation in the number of steps in a turn, averaged from daily monitoring, as measured at 6 weeks.

The difference in the Falls Efficacy Scale, as measured at baseline and 6 weeks. The Falls Efficacy Scale is a 16 item self-administered questionnaire to assess fear of falling. Scores range 16-64 with higher score indicating more fear of falling.

Number of prospective falls recorded for 12 months starting from the end of intervention

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. Single score provided at the end of 6 week period.

The number of steps in a turning averaged from daily monitoring, as measured at 6 weeks.

Peak velocity of turns averaged from daily monitoring, as measured at 6 weeks.

The peak size of turn angles averaged from daily monitoring, as measured at 6 weeks.

Time to complete turns averaged from daily monitoring, as measured at 6 weeks.

The coefficient of variation in time of double-support phase, as measured at 6 weeks.

The range of motion in the trunk during walking, in the lateral direction, as measured at 6 weeks.

The change in mini-Balance Evaluation Systems Test, a clinical measure of four balance domains-anticipatory, reactive, sensory, and dynamic gait, as measured at baseline and 6 weeks. 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. Single score provided at the end of 6 week period.

The difference in the Parkinson's disease questionnaire-39 (PDQ-39) - a 39 item self-report questionnaire to assess Parkinson's disease specific health related quality in eight domains of quality of life - as measured at baseline and 6 weeks. 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

Difference in the Unified Parkinson's Disease Rating Scale, Part III (UPDRS-III), as measured at baseline and 6 weeks.

The UPDRS-III is 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

The difference in Activities-Specific Balance Confidence (ABC) Scale, as measured at baseline and 6 weeks.

The ABC Scale is 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

Stride velocity during straight walking averaged from daily monitoring, as measured at 6 weeks.

Stride length during straight walking averaged from daily monitoring, as measured at 6 weeks.

The number of straight walking steps taken per minute averaged from daily monitoring, as measured at 6 weeks.

The amount of time both feet were on the ground together during straight walking averaged from daily monitoring, as measured at 6 weeks.

The angle between the foot and the ground at heel strike during straight walking averaged from daily monitoring, as measured at 6 weeks.

Coefficient of variation of the angle between the foot and the ground at heel strike during straight walking averaged from daily monitoring, as measured at 6 weeks.

The average number of turns per hour measured during daily monitoring at 6 weeks.