People with Parkinson's disease (PD) can exhibit disabling gait symptoms such as freezing of gait especially when distracted by a secondary task. Quantitative measurement method of this type of cognitive-motor abnormality, however, remains poorly developed. Here we examined whether stepping-in-place (SIP) with a concurrent mental task (e.g., subtraction) can be used as a simple method for evaluating cognitive-motor deficits in PD. We used a 4th generation iPod Touch sensor system to capture hip flexion data and obtain step height (SH) measurements (z axis). The accuracy of the method was compared to and validated by kinematic video analysis software. We found a general trend of reduced SH for PD subjects relative to controls under all conditions. However, the SH of PD freezers was significantly worse than PD non-freezers and controls during concurrent serial 7 subtraction and SIP tasking. During serial 7 subtraction, SH was significantly associated with whether or not a PD patient was a self-reported freezer even when controlling for disease severity. Given that this SIP-based dual-task paradigm is not limited by space requirements and can be quantified using a mobile tracking device that delivers specifically designed auditory task instructions, the method reported here may be used to standardize clinical assessment of cognitive-motor deficits under a variety of dual-task conditions in PD.

Background:Deficits in motor movement automaticity in Parkinson's disease (PD), especially during multitasking, are early and consistent hallmarks of cognitive function decline, which increases fall risk and reduces quality of life. This study aimed to test the feasibility and potential efficacy of a wearable sensor-enabled technological platform designed for an in-home music-contingent stepping-in-place (SIP) training program to improve step automaticity during dual-tasking (DT).Methods:This was a 4-week prospective intervention pilot study. The intervention uses a sensor system and algorithm that runs off the iPod Touch which calculates step height (SH) in real-time. These measurements were then used to trigger auditory (treatment group, music; control group, radio podcast) playback in real-time through wireless headphones upon maintenance of repeated large amplitude stepping. With small steps or shuffling, auditory playback stops, thus allowing participants to use anticipatory motor control to regain positive feedback. Eleven participants were recruited from an ongoing trial (Trial Number: ISRCTN06023392). Fear of falling (FES-I), general cognitive functioning (MoCA), self-reported freezing of gait (FOG-Q), and DT step automaticity were evaluated.Results:While we found no significant effect of training on FES-I, MoCA, or FOG-Q, we did observe a significant group (music vs podcast) by training interaction in DT step automaticity (P<0.01).Conclusion:Wearable device technology can be used to enable musically-contingent SIP training to increase motor automaticity for people living with PD. The training approach described here can be implemented at home to meet the growing demand for self-management of symptoms by patients.

BackgroundTimed single-leg-stance test (SLST) is widely used to assess postural control in the elderly. In Parkinson’s disease (PD), it has been shown that an SLST around 10 seconds or below may be a sensitive indicator of future falls. However, despite its role in fall risk, whether SLST times around 10 seconds marks a clinically important stage of disease progression has largely remained unexplored.MethodsA cross-sectional study where 27 people with PD were recruited and instructed to undertake timed SLST for both legs was conducted. Disease motor impairment was assessed with the Unified Parkinson’s Disease Rating Scale Part 3 (UPDRS-III).ResultsThis study found that: 1) the SLST in people with PD shows good test-retest reliability; 2) SLST values can be attributed to two non-overlapping clusters: a low (10.4 ± 6.3 seconds) and a high (47.6 ± 11.7 seconds) value SLST group; 3) only the low value SLST group can be considered abnormal when age-matched normative SLST data are taken into account for comparison; and 4) lower UPDRS-III motor performance, and the bradykinesia sub-score in particular, are only associated with the low SLST group.ConclusionThese results lend further support that a low SLST time around 10 seconds marks a clinically important stage of disease progression with significant worsening of postural stability in PD.

This study analysed how the relative positioning of players on court influenced patterns of interpersonal coordination in baseline rallies in tennis. We developed a model (PA index) that assigns a weight to the position of each player on court and determines a positional advantage, based on the relative proportionality between the lateral and longitudinal displacement values during rallies. To test the model, data from 27 randomly-selected baseline rallies from three ATP World Tour matches (professional tennis players' tournaments organized by Association of Tennis Professionals) on clay were analysed. Results revealed that the PA index of players on court described their interpersonal coordination dynamics during baseline rallies. It also identified the emergence of rally breaks in the interpersonal coordination patterns of competing dyads that led to a point being scored. Data suggest that positional advantage data may assist coaches in the design of training tasks to enhance players' court coverage and performance during competitive interactions, acting as a valuable tool for performance analysis in tennis.

These results suggest that the concurrent arm swing-stepping test can be used in conjunction with conventional psychometric assessments to facilitate multi-factorial assessment of potential fall risk.

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In tennis, the relative positioning of players on court constrains their opportunities to perform successful actions. In this study we proposed and validated an empirical function that captures the spatial-temporal relationship between tennis players during competitive performance. This parameter, termed goal-directed displacement index (GDD Index), is defined over time by the product of both players' distances to the central line of the court and to the centre of the net. Results showed that the GDD index successfully described tennis players' patterns of interaction, as well as identified breaks in patterns of play during competitive performance, due to changes in relative positioning on court. Our analysis revealed two different patterns of interpersonal interactions, cross and down-the-line rallies, and two ways for a break to emerge in game dynamics, parallel variation (transition from a cross court rally to a down-the-line rally) and angle opening (lateral displacement). Data suggest that the elaboration of specific individual profiles of performance for different players, using the GDD index, could improve performance analysis in tennis.