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Background: Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor impairments, especially in the area of gait disturbances. Physiotherapy, with a focus on task‐specific training, has demonstrated a level of efficacy as regards alleviating symptoms and enhancing functional capabilities in individuals with PD. Repetitive Transcranial Magnetic Stimulation (rTMS) has emerged as a potential therapeutic intervention for improving motor functions in individuals with PD. Aims: This review article aims to investigate the effects of combining rTMS with task‐specific training on gait performance in individuals with PD. Materials and Methods: PubMed, Physiotherapy Evidence Database (PEDro), and Scopus were all searched for relevant studies. The focus of the search was on studies that investigated the efficacy of combining rTMS with task‐specific training to improve gait performance in individuals with PD. Results: Four studies were identified as fulfilling the eligibility criteria and were included in the study. The combination of rTMS with specific treadmill training and weight‐bearing exercises can significantly enhance walking efficiency, including improvements in walking speed, self‐mobility, and step rate. In addition, the combination of rTMS and task‐specific training, such as treadmill‐based training, shows promise in enhancing gait performance in individuals with PD. Discussion and Conclusion: High‐frequency rTMS targeting the primary motor cortex (or M1) can result in improved walking speed, self‐mobility, and step rate. However, limited research exists regarding low‐frequency stimulation of the supplementary motor area (SMA) in individuals with gait issues. Further research is required to determine the optimal parameters of rTMS, such as strength, frequency, and duration of stimulation and it is worth considering the incorporation of additional training modalities, including cognitive exercises. [ABSTRACT FROM AUTHOR]

A limitation of the ability to rotate the head with respect to the upper body has been associated with turning problems; however, the extent of head constraints on whole-body coordination has not been fully determined. The aim of this study was to limit head on body rotation and observe the effects on whole-body coordination during standing turns at various speeds. Twelve participants completed standing turns at 180°. A Vicon motion system and a BlueGain Electrooculography system were used to record movement kinematics and measure horizontal eye movements, respectively. All participants were tested at 3 randomized speeds, and under 2 conditions with or without their head constrained using a head, neck, and chest brace which restricted neck movement. A repeated-measures analysis of variance found a significant main effect of turning speed on the onset latency of all segments, peak head–thorax angular separation, and step characteristics. Constraining the head rotation had multiple significant effects including delayed onset latency and decreased intersegmental coordination defined as peak head segmental angular separations, increased total step and step duration, and decreased step size. This indicates the contribution of speed, head, and neck constraints, which have been associated with falls during turning and whole-body coordination. [ABSTRACT FROM AUTHOR]

Biological sexes (male and female) have been reported to influence postural control and balance due to differences in musculoskeletal structures, hormonal factors, and neuromuscular control. These factors can contribute to the turning performance, potentially leading to an increased incidence of falls, particularly during turning. Therefore, this study aimed to explore the whole-body coordination and stepping characteristics and during standing turns in healthy adults to determine the effects of biological sex and turn speed. Fifty participants (25 males and 25 females) completed 180° standing turns on level ground. Inertial Measurement Units (XSENS) were used to measure whole-body movement turning kinematics and stepping characteristics. Moreover, clinical outcome of dynamic balance was measured by the Timed Up and Go (TUG). Participants were randomly tasked to turn at three speeds; fast, moderate, or slow to the left and right sides. Mann–Whitney U tests were used to compare the independent variables between male and females, and Friedman tests with Dunn's tests for pairwise comparisons were used to compare between the three turning speeds within the two groups. The results demonstrated that significant differences were seen between males and females during fast turning for the leading foot onset (p = 0.048) and in the slow speed for the total step (p = 0.033), showing that these were greater in female with an increase in turn speed. In addition, significant differences were seen only in the males when comparing different speeds in the trailing foot onset latency (p = 0.035), step size (p = 0.009), and total number of steps (p = 0.002), while in the females a significant difference was found in peak head yaw velocity between fast and slow turn speeds, and moderate and slow turn speeds. Finally, there was no significant difference in TUG between groups. Therefore, these findings show differences between biological sexes in the response to whole-body coordination and step characteristics, indicating that females tend to have more changes in stepping characteristics compared to males due to differences in turning speed. This can affect their balance and stability. However, the differences in biological sex did not impact the dynamic balance and fall risk due to the lack of a significant difference shown by TUG between males and females. [ABSTRACT FROM AUTHOR]

Issues around turning can impair daily tasks and trigger episodes of freezing of gait in individuals with Parkinson's disease (PD). Slow speeds associated with aging produce a more en-bloc movement strategy which have been linked with falls while turning. However, the influence of speed of turning on the complex whole-body coordination considering eye movements, turning kinematics, and stepping characteristics during turning has not been examined. The aim of this study was to investigate if individuals with PD have a different response to changes in turning speed compared to healthy older adults during 180° standing turns. 20 individuals with PD and 20 healthy age matched adults participated in this study. Data were collected during clockwise and counter-clockwise turns at three self-selected speeds in a randomised order: (a) normal; (b) faster than normal; and (c) slower than normal. Eye movement and turning kinematics were investigated using electrooculography and Inertial Measurement Units. Mixed Model Analysis of Variance (MM ANOVA) tests with post hoc pairwise comparisons were performed to assess the differences between groups and turning speed. In addition, further post hoc Repeated Measures ANOVA (RM ANOVA) tests were performed if any significant interactions were seen between groups and turning speed. Significant interaction effects were found in eye movement and turning kinematics, and the RM ANOVA showed significant main effects for turning speeds within the PD and the control groups. Turning slowly resulted in similar alterations in eye movement, turning kinematics and stepping characteristics in the PD group and the healthy controls. However, individuals with PD showed a different response to the healthy controls, with a greater delay in eye movement and onset latency of segments in turning kinematics and step variables between the different speeds. These findings help our understanding regarding the turning strategies in individuals with PD. The incorporation of guidance with regard to faster turning speeds may be useful in the management of individuals with PD. Clinical training using different turn directions and speeds may improve coordination, increase confidence and reduce the risk of falling. [ABSTRACT FROM AUTHOR]

Introduction: En bloc turning highlights a lack of rotational intersegmental coordination, which commonly impacts turning ability in people with Parkinson's disease (PD). Whilst this turning deficit responds fairly well to medical treatment, it may be further mitigated by performing specific exercise training. Thus, the present study aimed to examine the effects of a 4‐week exercise program, which focused on task‐specific movements (TSM program) on turning ability and clinical outcomes in people with PD. Methods: Twenty‐two adults (67 ± 6 years) with early‐to‐mid‐stage idiopathic PD were randomly assigned to an experimental group (EG; n = 11) or a control group (CG; n = 11). The exercise group (EG) group received a 60‐min per session TSM program for 4 weeks (a total of 15 sessions), while the CG group performed their routine rehabilitation program (a total of 12 sessions). Inertial measurement units were used to measure turning kinematics including; onset latency of body segments and stepping characteristics. Clinical outcomes included the Unified Parkinson's Disease Rating Scale (UPDRS), functional reach test (FRT), and fall efficacy scale international (FES‐I). Assessments were conducted at baseline and after 4 weeks. Results: In the EG, turning kinematics, UPDRS scores, FRT, and FES‐I scale, were improved at the end of the 4‐week program compared with the CG (all p < 0.05). Impact Statement: A 4‐week TSM program could be a promising alternative rehabilitation program for improving "en bloc" turns and clinical outcomes in PD patients. [ABSTRACT FROM AUTHOR]

It is well-established that processes involving changing direction or turning in which either or both standing and walking turns are utilized involve coordination of the whole-body and stepping characteristics. However, the turn context and whole-body coordination have not been fully explored during different turning amplitudes. For these reasons, this present study aimed to determine the effects of turning amplitude on whole-body coordination. The findings from this study can be utilized to inform the rationale behind fall prevention factors and to help design an exercise strategy to address issues related to amplitude of turning in older adults. Twenty healthy older and twenty healthy younger adults were asked to complete standing turns on level ground using three randomly selected amplitudes, 90°, 135° and 180°, at their self-selected turn speed. Turning kinematics and stepping variables were recorded using Inertial Measurement Units. Analysis of the data was carried out using Mixed Model Analysis of Variance with two factors (2 groups × 3 turning amplitudes) and further post hoc pairwise analysis to examine differences between factors. There were significant interaction effects (p < 0.05) between the groups and turning amplitudes for step duration and turn speed. Further analysis using Repeated Measure Analysis of Variance tests determined a main effect of amplitude on step duration and turn speed within each group. Furthermore, post hoc pairwise comparisons revealed that the step duration and turn speed increased significantly (p < 0.001) with all increases in turning amplitude in both groups. In addition, significant main effects for group and amplitudes were seen for onset latency of movement for the head, thorax, pelvis, and feet, and for peak head–thorax and peak head–pelvis angular separations and stepping characteristics, which all increased with turn amplitude and showed differences between groups. These results suggest that large amplitude turns result in a change in turning and stepping kinematics. Therefore, when assessing the turning characteristics of older adults or those in frail populations, the turning amplitude should be taken into account during turning, and could be gradually increased to challenge motor control as part of exercise falls prevention strategies. [ABSTRACT FROM AUTHOR]

Featured Application: This study explored a home-based exercise program during the COVID-19 pandemic that produced positive effects on gait characteristics and clinical outcomes in individuals with Parkinson's disease. Current restrictions on clinical visits as a consequence of the COVID-19 pandemic has increased the need for home-based exercise regimes to facilitate useful, long term patterns of behaviour in individuals with Parkinson's disease (PD). This study aimed to evaluate the effectiveness of a 10-week home-based exercise program designed to target improvements in axial rigidity and gait. The Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), motor scale and rigidity items, Functional axial rotation–physical (FAR-p), functional reach test (FRT), and time up and go (TUG) test were recorded. In addition, the 10-metre walk test, the fall efficacy scale international (FES-I) and the global rating of change score (GROC) were also recorded. Eighteen individuals were divided randomly into two groups: a home-based exercise group (n = 10) and a traditional physiotherapy control group (n = 8). Participants in the 10-week home-based exercise group showed significant improvements (p < 0.05) in the MDS-UPDRS rigidity item, FAR-p, step length, gait velocity, FRT and FES-I when compared with the control group. This study supports the use of home-based exercises in individuals with PD. These preliminary results also support the hypothesis that targeting axial deficits may be an effective approach for improving gait and reducing falls. [ABSTRACT FROM AUTHOR]

Purpose: To determine the level of evidence for exercise based rehabilitation and its effect on gait and turning performance which have been associated with a reduced incidence of falls. Methods and analysis: The five databases were searched systematically: PubMed, Scopus, Web of Science, Cochrane Library and Physiotherapy Evidence Database (PEDro). Articles comparing the effects of exercise-based treatment as an experimental intervention with a non-physiotherapy intervention (usual care, medication or education only) as the control were explored using the synthesis method. Results: Twelve out of the twenty-seven studies eligible for inclusion focussed explicitly on exercisebased treatment for gait and turning related to falls prevention in individuals with PD. Studies included specific exercise programs relevant to locomotion performance, Tai Chi and dance therapy which have all been shown to improve temporal, spatial and kinematic parameters in gait and turning, leading to improvements in fall parameters. Conclusion: This review evinces that Tai Chi, dance therapy and specific exercise programs can result in improvements in turning performance and may reduce the likelihood of falls in individuals with PD, however further research is required to explore the relationship between the benefits of exercisebased interventions on functional mobility and falls incidence. [ABSTRACT FROM AUTHOR]

Background: Axial rigidity is a common symptom in people with Parkinson's disease (PD) and is believed to contribute towards mobility problems and leads to an increased risk of falling. To date, effective treatment interventions to improve axial rigidity in PD have yet to be confirmed. Therefore, the aim of this scoping review was to identify and summarize the findings of exercise-based rehabilitation that have been successfully used to reduce axial rigidity in people with PD. Methods and analysis: Fourteen studies from the following databases were identified systematically: Cochrane Library, PEDro, Scopus, Web of Science and PubMed. Articles comparing the effects of exercise-based treatment as an experimental intervention with a non-physiotherapy intervention as the control were described using the synthesis method. Results: Four out of fourteen studies eligible for inclusion focussed explicitly on exercise-based treatment for axial rigidity in people with PD. Two studies suggested beneficial results of exercise in improving axial rigidity as evidenced by: improvement in the Unified Parkinson's Disease Rating Scale (UPDRS), axial rotation range, spinal flexibility and motion of the neck and trunk. Three further studies provided evidence for improvement of functional problems related to axial rigidity. Conclusion: The information about exercise-based rehabilitation for axial rigidity in people with PD is very limited. This review suggests that interventions aimed at reducing axial rigidity yield positive outcomes on functional performance i.e. improve trunk mobility, turning, balance and gait patterns, as well as reducing the risk of falls in people with PD. However, the association between axial rigidity and performance following specific exercise treatments has not been explored. Furthermore, there is still a lack of evidence for the effectiveness of specific home-based exercise programmes on alleviating axial rigidity in people with PD. Therefore, there is a need for well-designed large-scale studies to elucidate these questions. [ABSTRACT FROM AUTHOR]

Difficulty in turning is prevalent in older adults and results in postural instability and risk of falling. Despite this, the mechanisms of turning problems have yet to be fully determined, and it is unclear if different speeds directly result in altered posture and turning characteristics. The aim of this study was to identify the effects of turning speeds on whole-body coordination and to explore if these can be used to help inform fall prevention programs in older adults. Forty-two participants (21 healthy older adults and 21 younger adults) completed standing turns on level ground. Inertial Measurement Units (XSENS) were used to measure turning kinematics and stepping characteristics. Participants were randomly tasked to turn 180° at one of three speeds; fast, moderate, or slow to the left and right. Two factors mixed model analysis of variance (MM ANOVA) with post hoc pairwise comparisons were performed to assess the two groups and three turning speeds. Significant interaction effects (p < 0.05) were seen in; reorientation onset latency of head, pelvis, and feet, peak segmental angular separation, and stepping characteristics (step frequency and step size), which all changed with increasing turn speed. Repeated measures ANOVA revealed the main effects of speeds within the older adults group on those variables as well as the younger adults group. Our results suggest that turning speeds result in altered whole-body coordination and stepping behavior in older adults, which use the same temporospatial sequence as younger adults. However, some characteristics differ significantly, e.g., onset latency of segments, peak head velocity, step frequency, and step size. Therefore, the assessment of turning speeds elucidates the exact temporospatial differences between older and younger healthy adults and may help to determine some of the issues that the older population face during turning, and ultimately the altered whole-body coordination, which lead to falls. [ABSTRACT FROM AUTHOR]

Camera-based 3D motion analysis systems are considered to be the gold standard for movement analysis. However, using such equipment in a clinical setting is prohibitive due to the expense and time-consuming nature of data collection and analysis. Therefore, Inertial Measurement Units (IMUs) have been suggested as an alternative to measure movement in clinical settings. One area which is both important and challenging is the assessment of turning kinematics in individuals with movement disorders. This study aimed to validate the use of IMUs in the measurement of turning kinematics in healthy adults compared to a camera-based 3D motion analysis system. Data were collected from twelve participants using a Vicon motion analysis system which were compared with data from four IMUs placed on the forehead, middle thorax, and feet in order to determine accuracy and reliability. The results demonstrated that the IMU sensors produced reliable kinematic measures and showed excellent reliability (ICCs 0.80–0.98) and no significant differences were seen in paired t-tests in all parameters when comparing the two systems. This suggests that the IMU sensors provide a viable alternative to camera-based motion capture that could be used in isolation to gather data from individuals with movement disorders in clinical settings and real-life situations. [ABSTRACT FROM AUTHOR]