Investigator/Author: Lisa M. Muratori, PT, EdD
Objective: Falls can be devastating for Parkinson’s patients, with 20-30% requiring hospitalization after a fall and a large percentage permanently losing their independence. For many PD patients, performing a simultaneous cognitive task such as talking while walking can negatively affect the speed and accuracy of their gait—potentially increasing fall risk while also reducing social participation and quality of life. Traditional physical therapy interventions often focus on the single task of walking, but there is a growing understanding that PT for individuals with PD must include dual-task training to maximize benefits. Our study aims to clarify the cognitive relationship between walking and talking, and develop new dual- and multi-task interventions that will directly benefit Parkinson’s patients.
Background: This study is an expansion of a pilot study led by Lisa M. Muratori, PT, EdD, which was funded by a seed grant from Stony Brook’s Thomas Hartman Center for Parkinson’s Research. Additional funding will enable us to expand the study to include data from additional participants, which will be key to establishing sufficient preliminary data to advance the study’s objectives and seek NIH funding for a multi-center trial.
Methods/Design: Our study will build on previously-funded pilot data to further determine whether an innovative game-based treadmill intervention will improve walking speed, decrease gait deviations, improve measures of functional mobility, improve verbal fluency, etc. for individuals with PD. Participants will complete standardized questionnaires measuring quality of life and fear of falling, plus 16 physical therapy testing/training sessions (30 minutes each, 3 times per week for 4 weeks). During the sessions, participants will walk on a treadmill with and without the support of a specialized safety harness. While walking, individuals will participate in a proprietary video-based immersive game that will interact with their treadmill and increase in difficulty each week. During each session, vital signs will be recorded and specific data will be collected using standardized tests including: Functional Reach test, 6-Minute Walk test, Timed Up and Go test, Stops Talking When Walking (STWW) test, and Controlled Oral Word Association (COWA) test. Movements will also be recorded using a state-of-the-art motion analysis system to determine how temporal and spatial characteristics of gait are altered. Using this information, we will develop new multi-task physical therapy interventions with applications beyond treadmill training—to improve over-ground walking, functional mobility, and social participation for Parkinson’s patients.
Relevance to Diagnosis/Treatment of Parkinson’s Disease: In order to ensure full social participation and maintain optimal quality of life, while reducing fall risk, individuals with neurological disease must be able to safely move while engaging in decision making, social interactions, and other cognitive tasks. This study will lead to better physical therapy interventions to increase simultaneous motor and cognitive function for patients living with PD.
Expected Outcome: We expect our study to improve the scientific community’s understanding of the basis of cognitive and motor disturbances as they relate to PD. Testing will result in readily accessible and practical interventions for rehabilitation professionals working with PD patients, as well as preliminary data to pursue a larger clinical study.
November 2020 Project Update:
Since March 2020, Dr. Schwartz’s team has been working to translate A Matter of Balance to best meet the unique needs of people living with Parkinson’s Disease. To date, the team has developed a Parkinson’s-specific educational module, designed to supplement the current AMOB coach training. The educational module provides information specific to disease process, diagnosis, symptoms, fall risk factors, exercise and special considerations.
A coaches ‘toolkit’ is also in development and will include: a session-by-session “Special Considerations” fact sheet; Exercise and PD fact sheet; session-by-session curriculum modifications, including recommendations on how best to incorporate and support the care partner; and environmental modification fact sheet. Our team is currently working with Stony Brook University faculty to develop a student internship program, providing patient-specific, virtual learning opportunities for students while also innovating our program materials. The multi-disciplinary collaboration will allow us to recruit and train coaches from the healthcare field, as well as the broader community, increasing specialized training among our team and optimizing access to care for our patients and beyond.