Gait dysfunction is an early problem identified by patients with Parkinson's disease (PD). Alterations in gait may result in an increase in the energy cost of walking (i.e., walking economy). The purpose of this study was to determine whether walking economy is atypical in patients with PD when compared with healthy controls. A secondary purpose was to evaluate the associations of age, sex, and level of disease severity with walking economy in patients with PD. The rate of oxygen consumption (VO 2 ) and other responses to treadmill walking were compared in 90 patients (64.4±10.3 yr) and 44 controls (64.6±7.3 yr) at several walking speeds. Pearson correlation coefficients (r) were calculated to determine relationships of age, sex, and disease state with walking economy in PD patients. Walking economy was significantly worse in PD patients than in controls at all speeds above 1.0 mph. Across all speeds, VO 2 was 6 to 10% higher in PD patients. Heart rate, minute ventilation, respiratory exchange ratio, and rating of perceived exertion were correspondingly elevated. No significant relationship of age, sex, or UPDRS score with VO 2

The findings demonstrate that functional loss occurs at different points in the disease process, depending on the task under consideration. The resulting profile of functional limitations provides benchmarks that clinicians and researchers can use to interpret and monitor status of patients.

Background: People with lower-limb amputation (LLA) are routinely prescribed a socket prosthesis; however, many socket prosthesis users experience severe complications with the fit of their prosthesis including residual limb wounds and pain. Osseointegration is a procedure that creates a direct connection between the bone and prosthetic limb through a bone-anchored prosthesis, eliminating the need for a socket interface. It is offered as a secondary procedure to people with LLA who experience significant complications with socket prostheses. Objectives: To evaluate change in disability and function 1 year postosseointegration compared with preosseointegration in people with LLA. Study design: Single group, pretest, and post-test. Methods: Twelve participants (9 transfemoral and 3 transtibial amputations, age: 44 6 10 years, 7 female participants, 14 6 12 years since amputation) with unilateral LLA underwent osseointegration with press-fit implants. Disability was measured with the World Health Organization Disability Assessment Schedule 2.0, and function was measured with both Prosthetic Limb Users Mobility Survey and the Activities-Specific Balance Confidence Scale. Questionnaires were administered preosseointegration and 1 year postosseointegration. Paired t tests assessed change in outcomes between time points. Results: Postosseointegration, participants demonstrated reduced disability measured with World Health Organization Disability Assessment Schedule 2.0 (%D 5 252.6, p 5 0.01), improved mobility measured with Prosthetic Limb Users Mobility Survey (%D 5 21.8, P , 0.01), and improved balance confidence measured with the Activities-Specific Balance Confidence Scale (%D 5 28.4, P , 0.01). Conclusions: Participants report less disability and greater function in their prosthesis postosseointegration. Osseointegration is a novel procedure for people experiencing complications with their socket prosthesis, and this study is the first to show improvements in disability postosseointegration.

Objective The purpose of the study was to determine the impact of COVID-19 restrictions on community-based exercise classes for people with Parkinson disease (PD) and their instructors. Methods Data were collected via custom-designed electronic surveys for people with PD and class instructors who reported attending or teaching PD-specific exercise class ≥1/week for ≥3 months prior to pandemic restrictions (March 2020). The PD group also completed the Godin Leisure-Time Questionnaire (GLT-Q), Self-Efficacy for Exercise (SEE) scale, Schwab-England scale, and Parkinson’s Disease Questionnaire 8 (PDQ-8). Results Eighty-seven people with PD (mean = 70 [7.3] years old) and 43 instructors (51 [12.1] years old) from the United States completed surveys (October 2020 to February 2021). Mean Schwab-England (84 [16]) and PDQ-8 (21 [15]) scores indicated low-to-moderate disability in the PD group. Ninety-five percent of the PD group had COVID-19 exposure concerns and 54% reported leaving home ≤1/week. While 77% of the PD group scored “active” on the GLTQ, the mean SEE score (55 [24]) indicated only moderate exercise self-efficacy, and > 50% reported decreased exercise quantity/intensity compared to pre-COVID. There was decreased in-person and increased virtual class participation for both groups. The top in-person class barrier for the PD (63%) and instructor (51%) groups was fear of participant COVID-19 exposure. The top virtual class barriers were lack of socialization (20% of PD group) and technology problems (74% of instructor group). Conclusions During COVID-19 there has been less in-person and more virtual exercise class participation in people with PD, and decreased exercise quantity and intensity. Virtual classes may not fully meet the needs of people with PD, and primary barriers include technology and lack of socialization. Impact As COVID-19 restrictions wane, it is imperative to help people with PD increase exercise and activity. The barriers, needs, and facilitators identified in this study might help inform approaches to increase participation in exercise and activity for people with PD. Lay Summary During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD—and a decrease in exercise quantity and intensity. If you have PD, virtual classes might not fully meet your needs. Primary barriers may include technology problems and lack of social interaction.

Joint kinetic measurement is a fundamental tool used to quantify compensatory movement patterns in participants with transtibial amputation (TTA). Joint kinetics are calculated through inverse dynamics (ID) and depend on segment kinematics, external forces, and both segment and prosthetic inertial parameters (PIPS); yet the individual influence of PIPs on ID is unknown. The objective of this investigation was to assess the importance of parameterizing PIPs when calculating ID using a probabilistic analysis. A series of Monte Carlo simulations were performed to assess the influence of uncertainty in PIPs on ID. Multivariate input distributions were generated from experimentally measured PIPs (foot/shank: mass, center of mass (COM), moment of inertia) of ten prostheses and output distributions were hip and knee joint kinetics. Confidence bounds (2.5–97.5%) and sensitivity of outputs to model input parameters were calculated throughout one gait cycle. Results demonstrated that PIPs had a larger influence on joint kinetics during the swing period than the stance period (e.g., maximum hip flexion/extension moment confidence bound size: stance = 5.6 N·m, swing: 11.4 N·m). Joint kinetics were most sensitive to shank mass during both the stance and swing periods. Accurate measurement of prosthesis shank mass is necessary to calculate joint kinetics with ID in participants with TTA with passive prostheses consisting of total contact carbon fiber sockets and dynamic elastic response feet during walking.

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Background:Spatiotemporal gait asymmetries are a persistent problem for people with non-traumatic lower-limb amputation. To date, there is limited knowledge of multi-session gait training interventions targeting step length symmetry after non-traumatic amputation.Objective:The objective was to evaluate the feasibility and efficacy of an eight-session, treadmill-based error-augmentation gait training (EAT) protocol to improve spatiotemporal gait asymmetry in people with non-traumatic transtibial amputation (TTA).Study Design:Pre-post, single group. Methods: The EAT protocol involved eight training sessions (twice per week, four weeks) of supervised split-belt treadmill walking with asymmetrical belt speeds for five, three-minute sets each session. Step length symmetry during overground walking at a self-selected gait speed was assessed prior to, weekly, and one-week after the EAT protocol. Feasibility outcomes included protocol fidelity, safety, participant acceptability, and efficacy.Results:Seven of the eight participants (87.5%) completed the intervention at the prescribed dose. One participant developed a skin blister on their residual limb, which was possibly related to the intervention. No falls, musculoskeletal injuries, or increases in pain occurred. Participants rated EAT as acceptable based on scores on the Intrinsic Motivation Inventory – Interest/Enjoyment subscale (6.6 ± 0.5; mean ± SD). Average between-limb step length Normalized Symmetry Index improved (was reduced) one-week following EAT (2.41 ± 6.6) compared to baseline (5.47 ± 4.91) indicating a moderate effect size (d=0.53).Conclusions:An eight session EAT program delivered over four weeks using a split-belt treadmill is feasible for people with unilateral non-traumatic TTA and may reduce step length asymmetry up to a week after intervention.

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