Staci Shearin

Background and Purpose: Outcome measures are designed to identify functional mobility issues, safety concerns, and areas for intervention. While gait and balance are often evaluated separately, they interact significantly. Understanding how various outcome measures relate to gait performance may allow for more targeted interventions. The purpose of this study was to examine the relationship between dynamic balance, as assessed by the instrumented Four Square Step Test (i‐FSST), and gait parameters among community‐dwelling adults and individuals with neurological conditions (stroke, multiple sclerosis [MS], or Parkinson's disease [PD]). Methods: This cross‐sectional study used the i‐FSST to assess dynamic balance in 40 individuals typical of a neurologic clinic (11 community dwelling adults, 10 individuals with Parkinson's disease, 10 with multiple sclerosis, and 9 individuals post stroke). Outcome measures included FSST duration, stepping patterns, quadrant transition timing, and time spent in the quadrants. Gait was assessed using temporal‐spatial parameters (gait velocity, step length, gait variability index [GVI], double limb support [DLS], single limb support [SLS]). Results: The i‐FSST duration had a significant negative relationship with gait velocity ( r = −0.754) and step length ( r = −0.651). Additionally, i‐FSST duration had a significant relationship with single limb support (SLS) ( r = −0.593), double limb support (DLS) ( r = 0.588) and gait variability index (GVI) ( r = 0.594). ODS (defined as the number of double support periods) had a relationship with gait velocity ( r = −0.559), step length ( r = −0.562), GVI ( r = 0.573), SLS ( r = −0.538), DLS ( r = 0.539). CMS (indicates number of times weight is transfers between legs) correlated with gait speed ( r = −0.656), step length ( r = −0.663), and GVI ( r = 0.515). Discussion: The i‐FSST demonstrates multiple significant associations with key gait metrics, suggesting its clinical utility in assessing balance‐related factors that affect gait. Clinically, the test may aid in identifying impairments in weight shifting, directional movement, and dynamic balance.

One common gait issue associated with advanced Parkinson's disease (PD) is freezing of gait (FoG). FoG impacts approximately half of people with PD and negatively impacts quality of life. Studies have suggested that anxiety may contribute to FoG. Individuals with FoG exhibit higher rates of anxiety, but it is unclear if anxiety contributes to FoG development. No known studies have assessed the impact of treating anxiety to improve FoG symptoms. This pilot study evaluated the efficacy of cognitive behavioral therapy (CBT) training in reducing anxiety and improving gait in persons with PD following standard physical therapy (PT) treatment. Ten participants who had completed PT treatment for FoG were evaluated for psychological distress and gait parameters at baseline. They were then seen for four weekly virtual individual CBT sessions. Outcome measures were subsequently obtained 1 week after the CBT intervention and 5 weeks after the CBT intervention. Comparisons of baseline and postintervention Depression Anxiety Stress Scale-21 scores 1 week after the intervention were not statistically significant; however, improvements were both statistically and clinically significant a few weeks after the intervention, likely reflecting ongoing positive impact of CBT treatment. Gait parameters were noted to be clinically but not statistically significant after CBT treatment. This study suggests that a brief course of CBT may help to reduce emotional distress and to improve aspects of gait in a cohort of PD patients with FoG. Future research using a larger cohort and providing concurrent CBT/PT interventions is needed. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background/Objectives: Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms such as tremor, bradykinesia, rigidity, and postural instability. In the absence of disease-modifying therapies, exercise remains one of the few interventions shown to effectively reduce fall risk and improve mobility. However, it remains unclear whether skeletal muscle ATP metabolism is impaired in PD, and whether the benefits of exercise arise primarily from improvements in central motor control or peripheral metabolic adaptations. Methods: Fourteen individuals with PD and five healthy controls underwent kinetic ³¹P Magnetic Resonance Spectroscopy (MRS) to assess resting muscle ATP synthesis and dynamic ³¹P MRS during in-magnet exercise to evaluate oxidative phosphorylation in active muscle. Results: At rest, ATP synthesis rates mediated by ATPase and creatine kinase (CK) were on average 46 ± 23% and 24 ± 9% lower, respectively, in the PD group compared to controls (p < 0.005), suggesting peripheral mitochondrial dysfunction. During plantar flexion exercise at 15% of lean body mass, range of motion (ROM) was reduced by 22 ± 5% in PD participants (p = 0.01). Despite this, post-exercise recovery of phosphocreatine (PCr) and inorganic phosphate (Pi) was similar between groups. Recovery time constants for PCr and Pi correlated with participants’ total weekly exercise time, indicating a metabolic adaptation to regular physical activity. Modest ROM improvements were observed in both groups following calf-raise exercise training. Conclusions: Reduced skeletal muscle ATP metabolism may contribute to peripheral weakness in PD. Regular exercise appears to promote adaptive metabolic responses, highlighting the need for therapeutic strategies targeting both central and peripheral components of PD.

This paper presents the novel design of a multi-degree-of-freedom joint (M-DOF) for an ankle-foot orthosis (AFO) that aims to improve upon the commercially available double action joint (DAJ). The M-DOF is designed to maintain the functionality of the DAJ, while increasing dorsiflexion stiffness and introducing inversion/eversion. This increase in range of motion is designed to produce greater engagement from lower limb muscles during gait. The M-DOF was experimentally validated with one able-bodied and one stroke subject. Across walking speeds, the M-DOF AFO minimally affected the able-bodied subject's joint kinematics. The stroke subject's ankle dorsiflexion/plantarflexion and knee flexion were not heavily altered when wearing the M-DOF AFO, compared to the DAJ AFO. The new DOF allowed by the M-DOF AFO increased the inversion/eversion of the ankle by ∼3 deg, without introducing any new compensations compared to their gait with the DAJ AFO.

BACKGROUND: Parkinson disease (PD) is a progressive neurological disease resulting in motor impairments, postural instability, and gait alterations which may result in self-care limitations and loss of mobility reducing quality of life. OBJECTIVE: This study’s purpose was to determine the impact of a community-based boxing program on gait parameters, dual task and backwards walking in individuals with PD. METHODS: This study included 26 community dwelling individuals with PD who participated in 12-week boxing classes (1 hour, 2 times a week). The focus was on upper/lower extremity exercises using punching bags, agility drills, and strengthening activities. Pre/post testing was performed for dual task and gait parameters and was analyzed using t-tests. RESULTS: Analysis of the scores indicated participants performed significantly better at post-test compared to pre-test on self-selected walking velocity (P = 0.041), cadence (P = 0.021); backwards walking velocity (P = 0.003), step length (P = 0.022); dual task walking velocity (P = 0.044), step length (P = 0.023), and gait variability index (P = 0.008). No significant differences for fast walking. CONCLUSIONS: Multi-modal boxing produced improvements in gait velocity, dual task velocity, step length, and gait variability, as well as backwards walking velocity and step length. These improvements may impact independence with functional mobility and may improve safety but require further studies.

Parkinson’s disease affects the ability to walk often resulting in decreased independence and low quality of life. The purpose of this study was to examine differences in plantarflexor strength (PFS), gait speed, and step length in persons with Parkinson’s disease (PwP) and healthy peers using clinical measures. A secondary purpose was to examine the relationship between these gait components across disease severity. The study was a convenience sample of 71 PwP and 25 community healthy peers. Outcome measures included 10-Meter Walk, step length, and Calf-Raise Senior Test. PwP were separated into mild and moderate impairment groups using the Movement Disorders Society United Parkinson’s Disease Rating Scale Motor Subscale. Between group differences for gait speed (F _2,93 = 24.560, P = 0.000), step length (F _2,93 = 21.93, P = 0.000) and PFS (F _2,93 = 19.49, P < 0.000) were observed. Post hoc testing determined a difference (P < 0.00) in gait speed, step length, and PFS testing between moderate impairment versus healthy peers and mild impairment. A difference (P = 0.045) in step length and a trend towards significance (P = 0.064) for PFS was found between healthy peers and mild impairment group. This study revealed that PwP with mild impairment also have significant changes in step length and trends toward plantarflexor weakness without a significant difference in gait speed. These early changes may warrant early assessment and intervention to prevent decline. This study may bring clinical focus onto the plantarflexor and step length for early comprehensive assessment and treatment of gait and mobility for PwP.

: In college and graduate programs across the United States, educators have become aware that the psychological well-being of the current generation of students (often referred to as “Millennials”) needs to be an important area of focus. In 2007, 50.7% of American college students met the clinical criteria for a depressive or anxiety disorder. In the 2010 American College Health Survey, 48% of college and university respondents felt overwhelming anxiety at least once in the preceding year. These data make it clear that there is a need for effective interventions to help students reduce the emotional distress they experience. This pilot study examined the effects of an educational intervention on anxiety in graduate students. The intervention included cognitive behavioral therapy (CBT) and mindfulness training, in addition to education about lifestyle health behaviors and study habits. First year graduate students in the UT Southwestern School of Health Professions were recruited for the pilot study. The study design included 4 educational sessions to provide education/training in CBT, mindfulness, lifestyle, and study habits. Subjects completed outcome measures before and after the intervention including the Depression Anxiety Stress Scale-21 (DASS-21) and a survey about subjects' behaviors in the domains targeted in the study. Results indicated a decrease in student distress in DASS-21 overall and individual subtest scores. The results suggest that a comprehensive intervention was successful in impacting the depression, anxiety, and overall stress levels of the involved students.