The goal of this study was to determine if a robot-assisted exercise system could lead individuals with Parkinson’s disease (PD) through different joint ranges of motion in a fun and effective manner. Eleven individuals with PD participated. A novel robotic system placed a target at different places in space for participants to tap with their hand, foot or knee. The range of motion (ROM) was collected by inertial measurement units (APDM), and was extracted using a custom code (Matlab). ROM was dependent upon the exercise and joint of interest. Participants illustrated acceptable levels of fatigue during each session, based on an average ending heart rate of 107.0 ± 11.9 bpm (~70% of maxHR) and an ending RPE of 6.5 ± 1.8 on a 10-point scale, indicating that the sessions were appropriately challenging. Standing forward reach, used to assess static balance and flexibility, improved by an average of 1.7 inches (p < 0.01), demonstrating immediate improvements from exercising with the robot. The results demonstrate the potential benefits of exercising with a robotic exercise system. The number of sessions spent with a PT can be limited by availability, so this system could be a fun way to encourage individuals with PD to complete their PT exercises at home.

Background:Impaired visuospatial working memory (WM) often negatively impacts the quality of life of patients with Parkinson's Disease (PD). The Block Span Task (BST) is a novel Corsi-Block-like task adapted for use in functional magnetic resonance imaging (MRI) scanner to understand the neurophysiological mechanisms underlying visuospatial impairment in PD. This pilot study examines whether the BST is a practical tool to provide an in-scanner visuospatial WM task for older adults with mild-moderate PD. Methods:We recruited and assessed 21 older adults with mild-moderate PD (F = 9, M = 12, age: 70 ± 8 years, Hoehn and Yahr stage: 2.31 ± 0.54), with no overt dementia for participation in the task while lying in the scanner. They abstained from their anti-Parkinsonian medications for 12 h before the assessment. In scanner, participants viewed sequences of block locations on the screen before replicating the sequences on the corresponding buttons of a response pad. Following independent component analysis, components with positive, significant beta values were identified. Results:Administration of the BST task in an older PD population shows feasibility. Results from the encoding phase of the task were aligned with its intended design, implicating recruitment of neural networks with justifiable visuospatial WM involvement. The encoding phase of the task implicated recruitment of the superior temporal gyrus, superior medial frontal gyrus, precuneus, and posterior cingulate cortex, including auditory, cognitive, and default-mode networks. Conclusion:This pilot study provides initial evidence that impaired patients with PD can complete the BST fMRI task. Further, the BST appeared to engage significant neural regions that were consistent with an encoding condition in this population. Despite having a small sample size, these preliminary findings support that BST may be useful in future examination of visuo-spatial skills and the underlying brain mechanisms in patients with PD. Future works will be needed to replicate and refine these coarse and preliminary observations, and explore the degree of functional alterations in the recruited networks, when compared to healthy individuals.

BACKGROUND AND OBJECTIVES:Falls are a leading cause of injury and death among older adults (65 years and above). The Centers for Disease Control and Prevention's Stopping Elderly Accident, Deaths, and Injuries (STEADI) initiative aims to reduce falls by screening to find at-risk individuals, evaluation, and then addressing modifiable risk factors. This study evaluated the effectiveness of implementing a STEADI-based multi-component fall prevention approach via telemedicine in primary care. RESEARCH DESIGN AND METHODS:A randomized controlled quality improvement trial (STEADI Options) was conducted during the COVID-19 pandemic (July 2020-December 2021). Primary care professionals (PCPs) were randomized to either standard-of-care (SOC) or intervention. The intervention included a fall risk assessment by a research nurse, who shared STEADI-based recommendations with PCPs. Recommended interventions were administered at the discretion of PCPs. Outcomes included self-reported falls (primary), medically treated falls, fall-related service utilization (physical therapy, occupational therapy, eye care, podiatry), and medication changes, assessed over one year. Analyses followed an intent-to-treat approach. RESULTS:Among 660 participants (353 SOC; 307 intervention), the cohort was predominantly female (67.7%), aged 65-79 years (73.6%), and non-Hispanic White (56.1%). Intervention participants had higher average Stay Independent Screener (SIS) scores (6.3 vs. 5.2; p < 0.001). Overall, 5.5% reported a fall in the past 12 months. No significant differences were observed between groups in fall-related outcomes (e.g., medically treated falls odds ratio [adjusted for SIS]: 0.741; 95% CI: 0.411-1.336). DISCUSSION AND IMPLICATIONS:Although no significant differences were found, limited recruitment, low baseline fall rates, and unmeasured adherence may have impacted results. Further research is needed to evaluate the feasibility and effectiveness of telemedicine-based STEADI interventions in primary care.

Background:Breast cancer (BC) is among the most common forms of cancer, particularly among women. Chemotherapies that are most effective in treating BC are known to cause chemotherapy-induced neuropathy (CIN), thus leaving survivors with sensory deficits including pain, numbness, and tingling in the extremities; functional deficits such as impaired neuromotor control and motor-cognitive integration; reduced quality of life; and increased fall risk. Current pharmacologic treatments show limited efficacy and create additional unwanted side effects. In contrast, physical activity (PA) has emerged as a promising nonpharmacologic candidate for managing CIN symptoms. The purpose of this trial is to evaluate the effect of Adapted Argentine Tango (Tango) as a potential treatment for CIN. Toward this end, we will assess the intervention effect of Tango vs. the standard of care (SOC) on patient-reported outcomes of sensation, clinically-relevant measures of function, and potential mechanisms of action. We hypothesize that 4 weeks of Tango practice will improve sensation and function more than SOC among BC survivors with CIN and demonstrated balance dysfunction. Methods:In a multi-center, prospective, randomized controlled clinical trial, participants are randomly assigned (1:1 ratio) to the Tango experimental or the SOC active control arms. Primary outcomes are measured from baseline to after 4 weeks of intervention in patient-reported outcomes (PROs) of sensation and dual-task function. Secondary outcomes include additional PROs, such as fatigue, and clinical measures of interest after 4 and 8 weeks of intervention and 1 month following intervention completion. Exploratory measures include postural control, gait stability, cognitive load, and blood-based biomarker concentrations. Linear mixed models will be used to model changes in PROs and function. The primary estimand will be the difference in mean change in primary outcomes from baseline to week 4 between treatment groups. Discussion:The scientific premise of this study is that Tango stands to improve CIN symptoms significantly more than the current standard of care by combining PA with auditory-motor entrainment and social engagement. Our findings may lead to a safe non-pharmacologic intervention that improves CIN-related deficits. Trial registration:This trial was first posted on 12/27/24 at ClinicalTrials.gov under the identifier NCT06749210.

Parkinson’s disease disrupts motor control across multiple body parts, yet the neural mechanisms underlying these impairments remain incompletely defined. We compared resting-state functional connectivity in people with mild-to-moderate Parkinson’s disease ( n = 58) and neurotypical older adults ( n = 24), focusing on regions implicated in internally generated (IG) and externally generated (EG) movement pathways. For our analysis, we leveraged the reproducible NeuroMark independent component template and motor effector-specific mapping of primary motor cortex (M1). Our results reveal both increased and decreased connectivity patterns in Parkinson’s disease: M1 subregions associated with control of the leg, hand, and larynx showed robust increases in connectivity exclusively with cerebellar territories, particularly Crus II and Lobules VIIIa/VIIIb. The postcentral gyrus (primary somatosensory cortex) showed primarily increased connectivity with cerebellar regions and the insula. In contrast, the caudate nucleus displayed a mixed profile, with increased connectivity to the superior temporal gyrus and decreased connectivity to the superior medial frontal gyrus and cerebellar Crus II. Our motor effector-specific analysis of disease severity scores (MDS-UPDRS) in people with Parkinson’s disease revealed mild impairments across all categories (leg, hand, larynx) but disproportionately greater hand-related deficits, suggesting that some of the observed M1 connectivity differences may be influenced by these behavioral asymmetries. These anatomically precise, effector-specific alterations suggest compensatory recruitment of cerebellar circuits in Parkinson’s disease and provide a framework for targeting motor subcircuits in rehabilitation, including dance-based interventions.

BACKGROUND:Stopping Elderly Accidents, Deaths, and Injuries (STEADI) Options was a randomized trial of a telemedicine implementation of the CDC's STEADI older adult fall prevention initiative implemented among adults ages 65 and older at increased risk for falls. METHODS:Using STEADI Options and published data, we simulated the intervention's cost-effectiveness as compared to standard of care from the healthcare payer's perspective, over a one-year time horizon with a 0% discount rate. Using an incremental net benefit (INB) framework we estimated cost-effectiveness assuming a baseline willingness-to-pay (WTP) of $25 478 to prevent one medically treated fall and performed univariate and probabilistic sensitivity analyses. RESULTS:Cumulatively when compared to the control participants, those in the intervention cost -$873 (95% U.I. -$3839, $2081) less, experienced fewer falls treated within the healthcare system -0.037 (95% Confidence interval (C.I.), -0.090, 0.015), and fewer falls treated by other providers -0.007 (95% C.I. -0.070, 0.053). The intervention's INB of $1995 (95% U.I. -$2166, $6118) per enrollee, was cost saving in 71.8% of simulations and cost-effective in 82.9% of simulations. Cost-effectiveness was insensitive to wide changes in the model's parameters, was cost-effective in 71.8% of simulations at a WTP of $0 and 85.4% of simulations at a WTP of $50 000. CONCLUSION:Within the study cohort, the intervention was highly likely to be cost-effective. However, differences in medically treated falls and total healthcare costs were not statistically significant; therefore, we cannot rule out the possibility that the intervention had no impact.

BACKGROUND:Ballet strengthens leg muscles, improves balance, and lowers fall risk, but its effects on gait remain under-researched. This study analyzed spatiotemporal gait parameters, dynamic gait stability, and kinetic measurements during overground walking in young professional ballet dancers, older recreational ballet dancers, and non-dancers. METHODS:Sixty participants (10 young dancers, 10 young non-dancers, 20 older dancers, 20 older non-dancers) walked at their preferred pace while their full-body kinematics and kinetics were collected. Gait speed was the primary outcome. Secondary outcomes included gait parameters (step length and width, cadence) and dynamic gait stability. Kinetic variables (peak vertical ground reaction force, rate of loading, peak propulsive force, propulsive impulse) were tertiary outcomes. All outcomes were compared across groups. RESULTS:Dancers, regardless of age, walked faster (p = 0.012) with longer steps (p < 0.001) than non-dancers. Younger participants demonstrated narrower step widths (p < 0.001) and a lower cadence (p = 0.022) than their older counterparts. Stability at touchdown (p ≥ 0.067) and liftoff (p ≥ 0.243) was similar across groups. Dancers exhibited a larger rate of loading (p = 0.031) and generated greater peak propulsive force (p = 0.026) than non-dancers. CONCLUSIONS:Dancers of all ages walked faster and took longer steps than non-dancers. These kinematic differences between dancers and non-dancers may be associated with dancers' higher loading rates and greater propulsive forces. The kinetic differences are likely attributed to the stronger lower-limb mechanics developed through ballet. Despite the kinematic/kinetic differences, all groups showed comparable gait stability. These results offer valuable insights into the mechanisms underlying dynamic stability control in ballet dancers across ages.

center dot By integrating dance into your practice, you can provide a holistic approach that addresses physical, cognitive, and emotional health for your clients.center dot Dance can be used safely by a variety of clinical populations, including those with mental health issues and neurodegenerative disorders, to support physical and mental health and well-being.

Vascular dysfunction has been proposed as a contributor to age-related changes in movement and cognition; however, its associations with functional outcomes in older adults with amnestic mild cognitive impairment (MCI), clinically consistent with prodromal Alzheimer’s disease (pAD), remain unclear. This cross-sectional study analyzes baseline data from 73 older adults with amnestic MCI (mean age 74.6 ± 7.1 years). Vascular health is assessed using pulse wave velocity (PWV), aortic augmentation index (AIx), central mean arterial pressure (MAP), and subendocardial viability ratio (SEVR%). Standardized assessments evaluate cognitive, motor, and motor–cognitive performance. Multivariable regression analyses are performed, adjusting for age, sex, ethnicity, and antihypertensive medication use. A higher PWV is linked to poorer balance performance (β = −0.375, p = 0.025). Additionally, a higher SEVR% is associated with lower D-KEFS Inhibition-Switching performance (β = −0.053, p = 0.030). AIx is related to scores on the Montreal Cognitive Assessment (β = −0.079, p = 0.050). However, no statistically significant associations are observed between vascular measures and motor–cognitive outcomes. Furthermore, sex is significantly associated with both AIx (p = 0.038) and SEVR% (p = 0.045). Vascular measures are selectively associated with balance and specific executive functions in older adults with amnestic MCI. Vascular health, including arterial stiffness, may be a relevant correlate of early functional changes in pAD. Future longitudinal studies are needed to clarify the direction and clinical significance of these associations. As people age, problems with blood vessels can affect both movement and cognitive function, but the link between these changes in the early stages of Alzheimer’s disease (AD) remains unclear. In this study, we explored whether blood vessel health and arterial stiffness are linked to balance, movement, and cognitive abilities among older adults in the early stage of AD. We found that individuals with stiffer arteries had poorer balance and that measures of blood vessel function were linked to performance on tasks requiring planning and attention. Overall, these results suggest that blood vessel health may play an important role in abilities such as balance and cognition in this population. Larger studies are needed to confirm these findings. Rafie et al. examine associations between vascular health measures and motor and cognitive performance in older adults with amnestic mild cognitive impairment. Greater arterial stiffness is associated with poorer balance, while specific vascular parameters are linked to executive dysfunction and sex differences in vascular profiles.

BACKGROUND Up to 80% of individuals with breast cancer treated with chemotherapy develop chemotherapy-induced neuropathy (CIN), a dose-limiting neurotoxic response that degrades postural control, sensory function, and quality of life. To evaluate nonpharmacologic solutions for neuromotor dysfunction among individuals with breast cancer and CIN, we performed a randomized controlled trial of two physical activity protocols: Tango Dance (Tango) and Home Exercise (control). METHODS We enrolled 51 survivors (mean (SD) = 61.2(9.74) years; female: n = 50; male: n = 1) with breast cancer, CIN, and postural control deficits. We randomized participants 1:1 into Tango (n = 25) or Home Exercise (n = 26) intervention arms and conducted both interventions for 8 weeks, 2x per week, for up to 60 minutes per class. Postural control function was measured with eyes closed (QEC) and center of pressure (COP) variables calculated included postural sway amplitude (RMSr (primary), RMSx), sway area (COPa). Additionally, we evaluated patient-reported symptoms, clinical function, participation barriers, and adverse events. RESULTS Function, neuropathy symptoms, and fatigue improved with both Tango and Home Exercise intervention. Tango alone evidenced retention of postural control improvements after intervention end (RMSr, p = 0.0455; RMSx, p = 0.0165; COPa, p = 0.0183). Tango alone improved Common Terminology Criteria for Adverse Events patient-reported (PRO-CTCAE) symptoms at 4 (p = 0.0402) and 6 (p = 0.0110) weeks of training. CONCLUSION Both Tango and Home Exercise improve CIN-related deficits. Tango was superior to Home Exercise in two ways: alleviating symptoms at intervention midpoint and supporting retention of neuromotor gains. Further study is required to identify mechanisms driving these effects. TRIAL REGISTRATION NCT05114005 (registered 08/15/2021, completed 04/15/2024)

This narrative review examines the utility of gait digital biomarkers in Parkinson’s disease (PD) research and clinical trials across four contexts: disease susceptibility/risk, disease progression, response to exercise, and fall prediction. The review of the literature to date suggests that upper body characteristics of gait (e.g., arm swing, trunk motion) may indicate susceptibility/risk of PD, while pace aspects (e.g., gait speed, stride length) are informative for tracking disease progression, exercise response, and fall likelihood. Dynamic stability aspects (e.g., trunk regularity, double-support time) worsen with disease progression but can improve with exercise. Gait variability emerges as a sensitive biomarker across all 4 contexts but with low specificity. The lack of standardized gait testing protocols and the lack of a minimum set of quantified digital gait biomarkers limit data harmonization across studies. Future studies, using a commonly agreed upon protocol, could be used to demonstrate the utility of specific gait biomarkers for clinical practice.

Throughout humanity's existence, dance and creative movement have been used to express concepts, attitudes, and emotions, as well as to develop skills. Dance offers a paradigm to investigate neuroplasticity associated with learning sensorimotor interactions, and how these interactions enhance health, psychosocial, cognitive, and motor function, including for older individuals with neurotrauma and neurodegenerative disease. This collection explores the science of learning to move and its impact on cognition, how the neuropsychological aspects of the creative movement process is manifested in the brain, and how creative movement or dance can be harnessed to enhance health, cognitive function, and quality of life.

Background:The Activity Theory of Aging suggests sustained activity aids older adults to maintain high quality of life. Caregiving resilience coaching like the Dreaming Together (DTog) program may have helped caregivers for people with Lewy body dementia (LBD) sustain supportive activity throughout challenges from caregiving and pandemics. Objectives:To determine experiences and attitudes on sustaining activities during the COVID-19 pandemic of LBD caregivers participating in caregiving resilience coaching two years into the pandemic. Methods:13 participants (10 female; age=67.7 (9.9) years; Caregiver Quality of Life score=36 (12.9), "good"; Zarit Burden Interview score=72 (18.8), "mild to moderate") were recruited to participate in an Exit Interview held over Zoom right after DTog completion, between February and August of 2022. Participant responses were coded into themes through NVivo 12 software, for analysis relative to the Activity Theory of Aging. Results:Main themes: 1) Technology: An imperfect solution to social isolation; 2) Self-care is a necessity even during a crisis; 3) Caregivers Report A Reinforcing Negative Cycle of Declining Care Recipient Health and Adaptability. Conclusion:LBD caregivers, after completing the DTog resilience coaching program, maintained self-care activities that improved life satisfaction. Programs and studies promoting resilience-building activity should be considered to supporting LBD caregiving.

BackgroundNo effective therapies exist to prevent neurodegenerative mild cognitive impairment (MCI) related to Alzheimer's disease. Therapies integrating music and/or dance are promising non-pharmacological options to effectively mitigate cognitive decline.ObjectiveTo deepen our understanding of individuals' relationships (i.e., histories, experiences, and attitudes) with music and dance, in order to incorporate such knowledge into the design of music- and dance-based interventions, thereby improving therapeutic outcomes.MethodsEleven older adults with MCI and five of their care partners/ spouses (4 M/12F; Black: n = 4, White: n = 10, Hispanic/Latino: n = 2; Age: 71.4 ± 9.6 years) first completed questionnaires, then participated in focus groups that captured aspects of their relationships with music and dance. Emergent themes were extracted from four major topics, including: (1) experience and history, (2) enjoyment and preferences, (3) confidence and barriers, and (4) impressions of music and dance as therapeutic tools.ResultsThematic analysis revealed participants' positive impressions of music and dance as potential therapeutic interventions, citing perceived neuropsychological, emotional, and physical benefits. Participants viewed music and dance as integral to their lives, histories, and identities within a culture, family, and/ or community. Participants also identified lifelong engagement barriers that, in conjunction with negative feedback, instilled persistent low self-efficacy regarding dancing and active music engagement. Questionnaires verified individuals' moderately-strong music and dance relationships, which were strongest in passive forms of music engagement (e.g., listening).ConclusionsOur findings support that individuals' music and dance relationships and the associated perceptions toward music and dance therapy may offer valuable insights that enhance the design of efficacious and engaging non-pharmacological therapies for individuals with MCI.

Dance provides therapeutic benefits for people with Parkinson's disease (PD) across motor and non-motor domains, including gait, mobility, mood, and cognition (McNeely et al., 2015;Shanahan, 2015;Bek et al., 2020;Carapellotti et al., 2020;Emmanouilidis et al., 2021). As a low-cost and widely accessible activity, dance can be a valuable adjunct to standard clinical treatment for PD. Digital provision of dance for PD has expanded significantly, accelerated by the COVID-19 pandemic (Bek et al., 2021a;Kelly and Leventhal, 2021;Morris et al., 2021Morris et al., , 2023)). Accessible digital platforms for therapeutic activities such as dance continue to be needed (Ellis and Earhart, 2021;Kelly and Leventhal, 2021) to provide for the growing PD population (Dorsey et al., 2018), including those in rural and remote communities without access to in-person programs. This article considers key challenges and potential solutions in digital dance for PD.Preliminary evidence indicates that online dance can be safe and feasible for individuals with mild to moderate PD, with good rates of attendance and adherence and no adverse events (Morris et al., 2021(Morris et al., , 2023;;Walton et al., 2022;Pinto et al., 2023;Delabary et al., 2024b). Advantages of the digital format noted by people with PD include the convenience of not travelling and the ability to practice more frequently (Bek et al., 2021a;Ghanai et al., 2021). Participants report enjoyment of digital classes (Morris et al., 2021;Walton et al., 2022) and a desire to continue with online dance alongside in-person classes (Bek et al., 2021a;Delabary et al., 2024a), as also noted for exercise classes (Bennett et al., 2023) and singing therapy (Tamplin et al., 2024) for PD.Live online dance participation has been associated with improvements in functional mobility, anxiety, and depression (Shanahan et al., 2017;Walton et al., 2022;Pinto et al., 2023), affect (Ghanai et al., 2021), and quality of life (Walton et al., 2022) in people with PD. Participants with PD engaging in live and/or recorded digital dance programs during the pandemic self-reported multiple motor (e.g., balance, posture) and nonmotor (e.g., mood, confidence) benefits (Bek et al., 2021a).Digital formats thus show promise as a feasible and effective approach to dance for PD. However, the literature is limited, including small samples and different modes of delivery. As practice and research in this field continue expanding, it is important to consider how the digital environment might impact therapeutic benefits of dance programs. Dance is a multidimensional activity (Dhami et al., 2015;Christensen et al., 2017;Bek et al., 2022a) incorporating physical, cognitive, social, affective, and creative components that contribute to outcomes for people with PD. The following section outlines key therapeutic elements of dance that differ between inperson and digital contexts. with possible solutions to address limitations and optimise the experience and outcomes of digital dance programs. Table 1 summarizes key challenges and solutions.Therapeutic elements of dance that may be impacted in the digital environment Social interaction. The extent and nature of social interaction is altered by the absence of a group or partner in the digital environment (Bek et al., 2021a;Ghanai et al., 2021;Walton et al., 2022). Qualitative reports indicate that participants value the peer support, social comparison (Walton et al., 2022;Senter et al., 2024), and physical contact (Rocha et al., 2017;Delabary et al., 2024a) provided by in-person classes. Although enjoyment from social interactions can be compromised in digital programs (Emmanouilidis et al., 2021), meaningful social engagement can still be achieved. For example, virtual coffee time after class provides opportunities for discussion, questions, and feedback (Delabary et al., 2024a). Smaller live online classes with regular participants could also create a sense of community (Bek et al., 2022b). Social interaction in large classes could be supported by using "breakout" groups to facilitate discussion after class or by providing an online forum to promote interaction outside of classes.Quality of instruction and feedback. The effectiveness of instruction in the digital environment may be limited by factors including video/audio quality, viewing perspectives, and interaction with instructors (Bek et al., 2021a(Bek et al., , 2022b;;Delabary et al., 2024a;Tamplin et al., 2024). Feedback is important to ensure that movements are performed safely, provide necessary adaptations, and facilitate learning. A qualitative review of in-person dance for PD highlighted the value of the instructor-participant relationship (Senter et al., 2024). In contrast, reduced interaction with the instructor and the loss of one-to-one support were cited by participants with PD as disadvantages of digital classes (Bek et al., 2021a). These limitations may impact participants' motivation and confidence to engage as well as the potential for learning.Quality instruction may be maintained in the digital environment through optimising aspects of class design and production, such as slowing the teaching pace and repeating instructions (Delabary et al., 2024a). Live online classes are critical to enable participants to receive feedback. To facilitate high-quality feedback in digital programs, instructors could consider one-to-one or small group classes with volunteers or assistants to support participants during class. Participants should have opportunities to ask the instructor questions or make suggestions after class, which could be combined with social/coffee time (Bek et al., 2022a;Delabary et al., 2024a).Representation of movement and the body. Dancers frequently observe, imitate, mirror, and coordinate with others' movements (Blasing et al., 2012;Bek et al., 2020). These processes engage the brain's motor system to facilitate movement and learning (Hardwick et al., 2018;Chye et al., 2022). Interventions based on action observation and motor imagery have shown positive effects in PD (Caligiore et al., 2017;Bek et al., 2021b;Mezzarobba et al., 2024), and qualitative data suggest that observation and imagery may be effectively implemented within dance for PD (Bek et al., 2022a). Additionally, awareness of the body is an important element of dance, and in-person dance training may enhance body awareness in PD (Hadley et al., 2020). Body perception may be altered in the digital space (Delabary et al., 2024b), for example through seeing oneself on screen or having a more restricted area within which to move.Self-report data indicates that many people with PD can engage in observational learning and use imagery to enhance the outcomes of digital dance participation (Bek et al., 2021a(Bek et al., , 2022b)). These processes could be enhanced in digital programs through specific instructions to increase attention to the movements of the instructor and other dancers and to imagine the sensations of the demonstrated movements (i.e., kinesthetic imagery).Music and rhythm. Music is integral to dance and may contribute to beneficial effects for people with PD.Rhythmic cueing can also support gait in people with PD (de Dreu et al., 2011;Nombela et al., 2013). Music promotes dopamine release in the basal ganglia (Salimpoor et al., 2011), and the beneficial effects of music in PD extend beyond rhythm to influence affect and motivation (Karageorghis et al., 2020;Tamplin et al., 2020Tamplin et al., , 2024)). Music can also evoke motor imagery in people with PD (Poliakoff et al., 2023), and participants could potentially utilize the music from dance as an internalized cue to support movement in daily life (Bek et al., 2022a;Jola et al., 2022). People with PD enjoy the music accompanying dance classes and have expressed a preference for live music (Ghanai et al., 2021), which participants miss when dancing at home (Bek et al., 2021a).In a recent study examining the feasibility of a one-on-one digital dance program for PD, participants worked with the instructor to select music for classes (Morris et al., 2021). Although it may be difficult to effectively tailor music to preferences in a group online class, different choices could be accommodated across a series of classes. Instructors should ensure appropriate music quality and volume (Delabary et al., 2024a), and participants could be supported to optimize the audio settings of their devices.Aesthetics and creativity. The creative aspects of dance differentiate it from other forms of physical activity (Rocha et al., 2017;Fontanesi and DeSouza, 2021;Bek et al., 2022a). Dance programs for PD often feature communicative expressions and gestures, storytelling, and props. Qualitative data indicate that participants enjoy the creativity and escapism offered by dance (Bek et al., 2022a;Walton et al., 2022) and that artistic aspects of dance are diminished in the digital environment (Walton et al., 2022). Additionally, skin conductance measures have indicated that dance may increase physiological arousal compared to an exercise program of similar aerobic intensity (Fontanesi and DeSouza, 2021), suggesting an emotional response to the artistic experience of dance. To enhance the aesthetic and creative dimensions of digital dance programs, participants could be encouraged to contribute to choreographic themes and stories or use props during home practice.Instruction could also incorporate analogy and metaphorical imagery, which has been associated with positive outcomes of digital dance participation (Bek et al., 2021a). Further to the therapeutic elements of dance discussed above, there are important practical considerations in designing digital programs. Ensuring safety in the digital environment is critical, particularly considering gait and balance difficulties in PD, which can increase fall risk (Camicioli et al., 2023). People with PD who attend dance classes are at different stages of disease progression and can have different needs. They may also have different infrastructures at home to support online physical activity. It is important for health professionals and instructors to ensure that participants are safe to engage in home-based dance training, particularly those with greater disease severity who experience postural instability. Checklists have been devised to assist this process (see Morris et al 2021Morris et al , 2023)). It is also advisable to use a checklist before each session to assess safety of the home environment and note procedures for dealing with adverse events. Technical barriers relating to the hardware, software, or connectivity required for online classes must also be considered for both participants and instructors (Bek et al., 2021a(Bek et al., , 2022b;;Walton et al., 2022;Delabary et al., 2024a).To increase the accessibility of dance programs, alternative options could be offered to accommodate different abilities and preferences. While most participants may prefer live online classes that provide greater social interaction, others prefer recorded videos that offer flexibility and enable self-paced or repeated practice, or appreciate having both live and recorded options (Bek et al., 2021a). Pre-recorded DVDs or dance instruction by telephone 1 could provide valuable resources for individuals in rural communities without reliable internet access or a suitable electronic device, and these should also incorporate appropriate safety checks. A choice of different digital platforms for accessing classes could also increase participation by providing options that participants are familiar with (Delabary et al., 2024a). Participants could also be supported with training or guidance to use the required technology before joining a program. Involving people with PD in the co-design and development of programs increases the relevance and could enhance outcomes of therapeutic activities like dance (Quinn et al., 2010;Morris et al., 2021;Bek et al., 2022a). Participant input is particularly valuable in digital programming to understand specific preferences, needs, and challenges. High levels of attendance and enjoyment of co-designed online dance classes have been reported (Morris et al., 2021), and patient input can 1 These options are already offered by Dance for PD® https://danceforparkinsons.org/ enhance the accessibility and usability of digital technology platforms for home-based training (Bek et al., 2021b).Finally, future research and development should capitalize on the opportunities offered by artificial intelligence (AI) to enhance and personalize digital therapies (Amjad et al., 2023), including the possibility to provide participants, dance instructors, and healthcare professionals with performance data and feedback. For example, computer vision and machine learning techniques could be used to measure changes or improvements in movement and adjust programs to fit individuals' ability levels. Participants could also receive individualized encouragement and guidance. AI could also allow instructors to tailor classes to different languages, cultures, and geographical locations, for example through translating instructions or suggesting culturally relevant music and themes.Current evidence indicates that digital dance is feasible and enjoyable for many people with PD, and preliminary findings suggest that positive outcomes can be achieved in the online environment. Digital platforms can increase the reach of dance programs, although barriers to access remain. However, the evidence so far is limited to small-scale studies and self-report data, and the outcomes of digital and in-person programs have not been directly compared. Further research is needed to understand the impact of digital dance across domains and at different disease stages, including longer-term outcomes. In the meantime, this article outlines possible solutions to help maintain therapeutic benefits of dance in the digital environment.

Introduction:Parkinson's Disease (PD) is commonly treated with the dopamine precursor, levodopa, which is used in antiparkinsonian therapy. After several years of taking this medication, many individuals with PD experience medication-related motor fluctuations (MRMF), a.k.a., OFF-time. OFF-time is one of the most disconcerting features of PD when troubling motor and non-motor symptoms previously alleviated by levodopa return. Exercise, specifically dance, could beneficially address OFF-time and enhance quality of life (QOL) and independence in people with PD. Methods:This assessor-blinded randomized controlled trial (1:1) [NCT04122690] included 45 participants with PD (70.1±7.27 years, 73% male, 2.30±0.61 Hoehn & Yahr stage), who were randomized into 30 hours of PDAE or WALK over 3 months. Psychosocial questionnaires, MDS-UPDRS, and 3-day OFF-state diaries were administered at baseline and three-month timepoints to measure reported OFF-time, QOL, independence, and disease severity. Within-group comparisons were analyzed using paired t-tests, and between-group comparisons were analyzed using independent t-tests and a linear mixed-effects model. Results:After three months, PDAE reduced OFF-time and improved motor symptoms. Compared to WALK, PDAE also reduced OFF-time, improved motor symptoms, and enhanced the experience of daily living. Conclusion:PDAE is superior to WALK and is an effective adjunctive therapy to help improve OFF-time and QOL in individuals with PD after three months. Further studies are needed to determine the relationship between improving OFF-time and quality of life.

Background/Objectives: Robot-led rehabilitative exercise offers a promising avenue to enhance the care provided by exercise specialists (ESs). ESs, such as physical and occupational therapists, prescribe exercise regimens to clinical populations to improve patients’ adherence to prescribed exercises outside the clinic, such as at home. Collaborative efforts among roboticists, clinical ESs, and patients are essential for developing interactive, personalized exercise systems that meet each stakeholder’s needs. This work builds upon research involving individuals with Parkinson’s disease (PD) that evaluated a robotic rehabilitative exercise system designed to address strength and flexibility deficits. Methods: To complement the findings of our previous work in people with PD (PWP), we conducted a pilot user study in which 11 ESs evaluated a novel robot-led exercise system for PWP, focusing on perceptions of the system’s efficacy and acceptance. Utilizing a mixed-methods approach, including technology acceptance questionnaires, task load questionnaires, and inductively coded semi-structured interviews, we gathered comprehensive insights into ES perspectives and experiences after interacting with the system. Results: Findings reveal a broadly positive reception, which highlights the system’s capacity to augment traditional rehabilitative exercise for PD, enhance patient engagement, and ensure consistent exercise support. We also identified two key areas for improvement: incorporating more human-like feedback systems and increasing the robot’s ease of use. Conclusion: This research emphasizes the value of incorporating robotic assistants into rehabilitative exercise for PD, offering insights that can guide the development of more effective and user-friendly rehabilitation technologies.

BACKGROUND PURPOSE:Cognitive deficits associated with mild cognitive impairment (MCI) likely impact balance control, especially during dynamic tasks. The Four Square Step Test (FSST) presents concurrent obstacle step-over and multi-directional stepping tasks to clinically interrogate dynamic balance. The primary FSST outcome, completion time , delivers a coarse measure of dynamic balance control, but cannot reveal underlying kinematic strategies that may further characterize MCI-related balance deficits. The objective of this study was to use an augmented FSST to characterize aging and MCI effects on both dynamic balance performance and lower-extremity kinematic execution strategies. METHODS:Younger adults (YA, mean age = 23.7y; n = 7), older adults (OA, mean age = 67.4y; n = 20), and individuals with MCI (MCI, mean age = 71.7y; n = 17) performed the FSST in an observational study. We compared overall group effects, then performed 2-way, post-hoc comparisons to identify age (YA vs OA) and cognitive (OA vs MCI) differences in: (1) FSST completion times indicating dynamic balance performance , and (2) lower-extremity peak joint angles during leading and trailing steps in anterior-posterior and lateral directions, indicating kinematic execution strategies . RESULTS DISCUSSION:The FSST completion time was impaired in OA compared to YA (31% slower; p < .001) and in MCI compared to OA (18% slower, p = .008). Both YA and OA exhibited similar kinematics throughout. Individuals with MCI exhibited reduced knee flexion across steps compared to OA ( p ≤ .002). Reduced knee flexion was associated with degraded FSST performance (Pearson's r < -0.44) and is generally less amenable to the obstacle step-over sub-task. While longer FSST completion times revealed aging-and MCI-related impacts on dynamic balance performance, kinematic analyses further revealed altered dynamic balance strategies only in individuals with MCI. CONCLUSIONS:Deficits associated with MCI impair FSST performance. Altered lower-extremity kinematics suggest that individuals with MCI may be especially challenged by the complexity of concurrent multi-directional stepping and obstacle step-over FSST sub-tasks. Clinicians should consider both impaired overall performance and underlying kinematic strategies when characterizing altered dynamic balance control during complex tasks (eg, FSST) in individuals with MCI.

Background:Caring for someone with Lewy Body Dementia (LBD) is mentally and physically taxing. The Activity Theory of Aging associates reduced activity levels with lower life satisfaction in older adults. With the onset of the coronavirus-19 pandemic (COVID-19), and less activity for many older adults, LBD caregiving burden may have increased along with decreased life satisfaction. Objectives:To determine the unique experiences, perceptions, attitudes, and beliefs of LBD caregivers regarding activity and its relationship to life satisfaction in the early months of COVID-19. Methods:A Focus Group of five LBD Caregivers and one Care Recipient was held over Zoom in October 2020. Participant responses were analyzed using NVivo 12 software, using the framework of the Activity Theory of Aging to guide analysis. Results:Main themes revealed the poignance of experiences of navigating COVID-19 while caregiving, caregiver concerns, and the care recipient concerns. Subthemes highlight social isolation and reduced activity, motor/cognitive/emotional decline, and related coping strategies to improve life satisfaction. Conclusion:Caregiving experiences were impacted by activity level, reflecting the Activity Theory of Aging. Future studies with larger samples on the extended COVID-19 impact for LBD caregivers are needed.