People with Parkinson's disease exhibit deficits in gait, speech and dexterity.• The usability of a mobile health (mHealth) smartphone application designed to target symptoms of gait, speech and dexterity in Parkinson's disease was investigated. • Primary outcome measures included adherence, gait characteristics, number of steps per day, sustained phonation, speech prosody and the 9-hole peg test. • Adherence to the mHealth application was moderate and there was little effect on gait, speech and dexterity.• Increased adherence to mHealth treatment was not associated with improved outcomes.• User-friendly mHealth to complement traditional rehabilitation may improve efficacy.Aim: This study investigated the usability of a mobile health (mHealth) smartphone application to treat gait, speech and dexterity in people with Parkinson's disease. Methods: Participants either used an mHealth application (intervention) or maintained their normal routine (control) for 12 weeks and were evaluated at baseline and post-test time points for primary outcome measures of adherence, gait, speech and dexterity. mHealth application adherence was compared with percent change scores on gait, speech and dexterity measures. Results: Adherence was moderate and there were no significant group, time or interaction effects for any outcome measures. Correlations between adherence and outcomes were weak and negative. Conclusion: These data suggest that usability of this mHealth application was limited as indicated by low adherence. The application alone in its present form was not adequate to treat symptoms of gait, speech or dexterity in people with Parkinson's disease.

People with Parkinson disease demonstrate increased gait variability, but the primary variability sources are poorly understood. People with Parkinson disease and freezing of gait (freezers) have greater gait impairments than people with Parkinson disease without freezing of gait (nonfreezers), which may relate to cerebellar dysfunction. Thirteen freezers and 31 nonfreezers completed backward, forward, and forward with dual task gait trials. Sagittal joint angle waveforms were extracted for the hip, knee, and ankle using 3D motion capture. Decomposition indices were calculated for the 3 joint combinations. Principal component analysis extracted variance sources from the joint waveforms. Freezers had significantly greater decomposition between hip–ankle (F1,42 = 5.1, P = .03) and hip–knee (F1,42 = 5.3, P = .03) movements. The principal component analysis did not differentiate freezers and nonfreezers; however, primary variance sources differed between conditions. Primary variance during forward and forward with dual task gait came from joint angle magnitude and peak angle timing. Backward gait showed primary variance from joint angle magnitude and range of motion. The results show that freezers decompose movement more than nonfreezers, implicating cerebellar involvement in freezing of gait. Primary variance differs between gait conditions, and tailoring gait interventions to address variability sources may improve intervention efficacy.

Individuals with Parkinson's disease (PD) experience postural instability, low-back pain (LBP), and anxiety. These symptoms increase the risk of falls and decrease quality of life. Research shows yoga improves balance and decreases LBP and anxiety in healthy adults, but its effects in PD are poorly understood. All participants were part of a larger intervention study. Participants received pretest and posttest evaluations, including the Balance Evaluation Systems Test (BESTest), Beck Anxiety Inventory (BAI), and Revised Oswestry Disability Index (ROSW). Total scores for each measure, as well as individual balance system section scores from the BESTest (biomechanical constraints, stability limits/verticality, transitions/anticipatory, reactive, sensory orientation, and stability in gait) were compared within groups pre- to posttest. Participants in the yoga group ( n = 13) completed a twice-weekly 12-week yoga intervention, whereas controls ( n = 13) continued their usual routines for 12 weeks. Both the yoga ( Z = −3.20, p = 0.001) and control ( Z = −2.10, p = 0.040) groups improved on the BESTest total score. The control group showed no changes in individual balance systems, whereas the yoga group improved in stability limits/verticality ( Z = −2.3, p = 0.020), transitions/anticipatory ( Z = −2.50, p = 0.010), reactive ( Z = −2.70, p = 0.008), and sensory orientation ( Z = −2.30, p = 0.020). ROSW decreased in the yoga group only ( Z = −2.10, p = 0.030). BAI did not change in either group. Yoga is a nonpharmacological intervention that can improve balance and LBP in people with PD. This study demonstrated that yoga is feasible for people with PD, and participants reported high levels of enjoyment and intent to practice yoga after the study.

Brain regions important for controlling movement are also responsible for rhythmic processing. In Parkinson disease (PD), defective internal timing within the brain has been linked to impaired beat discrimination, and may contribute to a loss of ability to maintain a steady gait rhythm. Less rhythmic gait is inherently less efficient, and this may lead to gait impairment including reduced speed, cadence, and stride length, as well as increased variability. While external rhythmic auditory stimulation (e.g. a metronome beat) is well-established as an effective tool to stabilize gait in PD, little is known about whether self-generated cues such as singing have the same beneficial effect on gait in PD. Thus, we compared gait patterns of 23 people with mild to moderate PD under five cued conditions: uncued, music only, singing only, singing with music, and a verbal dual-task condition. In our single session study, singing while walking did not significantly alter velocity, cadence, or stride length, indicating that it was not excessively demanding for people with PD. In addition, walking was less variable when singing than during other cued conditions. This was further supported by the comparison between singing trials and a verbal dual-task condition. In contrast to singing, the verbal dual-task negatively affected gait performance. These findings suggest that singing holds promise as an effective cueing technique that may be as good as or better than traditional cueing techniques for improving gait among people with PD.

Walking can be challenging for aging individuals and people with neurological disorders such as Parkinson disease (PD). Gait impairment characterized by reduced speed and higher variability destabilizes gait and increases the risk of falls. External auditory cueing provides an effective strategy to improve gait, as matching footfalls to rhythms typically increases gait speed and elicits larger steps, but the need to synchronize to an outside source often has a detrimental effect on gait variability. Internal cueing in the form of singing may provide an alternative to conventional gait therapy. In the present study, we compare the effects of internal and external cueing techniques on forward and backward walking for both people with PD and healthy controls. Results indicate that internal cueing was associated with improvements in gait velocity, cadence, and stride length in the backward direction, and reduced variability in both forward and backward walking. In comparison, external cueing was associated with minimal improvement in gait characteristics and a decline in gait stability. People with gait impairment due to aging or neurological decline may benefit more from internal cueing techniques such as singing as compared to external cueing techniques.