Consecutive and integrated dual-task training led to similar and sustained improvements in dual-task gait velocity without increasing fall risk. These novel findings support adoption of dual-task training in clinical practice. © 2017 International Parkinson and Movement Disorder Society.

Dual-task (DT) circumstances aggravate gait disorders in Parkinson's disease (PD) and are associated with an increased risk of falling and reduced functional mobility. Clinical rehabilitation guidelines for PD consider DT interventions as potentially hazardous and recommend avoiding them in daily life. The current article challenges this notion and addresses the necessity of implementing DT training in PD. First, underlying reasons for DT interference in PD and current theoretical models are discussed. Subsequently, different training approaches to tackle DT difficulties are put forward. Finally, the effectiveness and limitations of DT training in PD are reviewed. We conclude that there is a need for DT interventions in PD and recommend randomized, power-based studies to further test their efficacy.

We found both integrated and consecutive dual-task training to be safe and effective in improving several spatiotemporal gait parameters under trained and untrained dual-task conditions.

Background Background: Freezing of gait (FOG) is a common gait deficit in Parkinson's disease. The New Freezing of Gait Questionnaire (NFOG-Q) is a widely used and valid tool to quantify freezing of gait severity. However, its test-retest reliability and minimal detectable change remain unknown. Objective Objective: To determine the test-retest reliability and responsiveness of the NFOG-Q. Methods Methods: Two groups of freezers, involved in 2 previous rehabilitation trials, completed the NFOG-Q at 2 time points (T1 and T2), separated by a 6-week control period without active intervention. Sample 1 (N = 57) was measured in ON and sample 2 (N = 14) in OFF. We calculated various reliability statistics for the NFOG-Q scores between T1 and T2 as well as correlation coefficients with clinical descriptors to explain the variability between time points. Results Results: In sample 1 the NFOG-Q showed modest reliability (intraclass correlation coefficient = 0.68 [0.52-0.80]) without differences between T1 and T2. However, a minimal detectable change of 9.95 (7.90-12.27) points emerged for the total score (range 28 points, relative minimal detectable change of 35.5%). Sample 2 showed largely similar results. We found no associations between cognitive-related or disease severity-related outcomes and variability in NFOG-Q scores. Conclusions Conclusions: We conclude that the NFOG-Q is insufficiently reliable or responsive to detect small effect sizes, as changes need to go beyond 35% to surpass measurement error. Therefore, we warrant caution in using the NFOG-Q as a primary outcome in clinical trials. These results emphasize the need for robust and objective freezing of gait outcome measures.Freezing of gait (FOG) is a prominent and debilitating symptom of Parkinson's disease (PD). It affects up to 80% of PD patients during the course of the disease. 1-3 FOG is defined as the inability to progress forward stepping despite the intention to walk and reach a destination. 4 Furthermore, FOG is one of the most frequent causes of falls in PD, thus contributing to high fall rates ranging from 35% up to 90%. 1,5,6 FOG seriously impedes daily life functioning and overall quality of life. 7,8 So far, the treatment of FOG, including pharmacological, surgical, and rehabilitation interventions, is only partially effective. 4,9 Therefore, new and more personalized rehabilitation approaches are now being developed. To evaluate their effectiveness, valid and reliable assessment is necessary to document FOG severity and its progression.A recent review of Mancini and colleagues 10 highlighted that FOG assessment is hampered by several factors in clinical and laboratory settings. First, the episodic and unpredictable nature of FOG increases the likelihood of missing the event during formal or "online" performance tests of gait. Second, various "testing effects" may be at play that enhance or reduce the occurrence of FOG, such as consciously attending to walking, stepping in broad and well-lit corridors, and experiencing medication effects and...