Background. Rhythmic auditory stimulation (RAS) can influence movement during straight line walking and direction transition in individuals with Parkinson disease (PD). Objective. The authors studied whether multidirectional step training with RAS would generalize to functional gait conditions used in daily activities and balance. Methods. In a matched-pairs design, 8 patients practiced externally paced (EP) stepping (RAS group), and 8 patients practiced internally paced (IP) stepping (no RAS group) for 6 weeks. Participants were evaluated on the first and last days of practice, and 1 week, 4 weeks, and 8 weeks after practice termination. Evaluations included a primary measurementthe Dynamic Gait Index (DGI)-and secondary measurements-the Unified Parkinson's Disease Rating Scale (UPDRS), Tinetti-gait and balance tests, Timed-Up-and-Go (TUG), and Freezing of Gait Questionnaire (FOGQ). Results. The RAS group significantly improved performance on the DGI and several secondary measures, and they maintained improvements for the DGI, Tinetti, FOGQ, and balance and gait items of the UPDRS above pretraining values at least 4 weeks after practice termination. The no RAS group revealed several improvements with training but could not maintain these improvements for as long as the other group. Conclusions. Individuals with PD can generalize motor improvements achieved during multidirectional step training to contexts of functional gait and balance. Training with RAS is advantageous for enhancing functional gait improvements and the maintenance of functional gait and balance improvements over 8 weeks.

Measurements of first ray mobility, pressure, and other variables were made on 19 diabetic patients with a history of ulceration at the first metatarsal head, 20 diabetic patients with a history of ulceration at other locations of the forefoot, 19 matched diabetic controls, and 19 matched nondiabetic controls. Patients with a history of first metatarsal head ulceration had significantly less first ray mobility and significantly higher pressure at the first metatarsal head compared with the other groups. Regression analysis found a moderate inverse linear relationship between first ray dorsiflexion and peak pressure at the first metatarsal head (R2 = 0.46, P < .0001). Results showed that sensory loss, duration of diabetes, and limited range of motion at the hip, ankle, and foot were related to ulcerations at all forefoot locations, Limited first ray mobility and high pressure at the first metatarsal head were related to ulcerations only at the first metatarsal head location.

Selected combinations of multidensity orthotic materials were tested under simulated walking conditions found in the forefoot of diabetic patients. Materials were compared for therapeutic effectiveness by their stress/strain properties and dynamic compression set. Results showed that all of the multidensity materials experienced losses in performance throughout the testing period of 100,000 cycles, with the greatest losses occurring within the first 10,000 cycles. Of the materials tested, Poron + Plastazote #2 and Spenco + Microcel Puff Lite had the highest dynamic material strain and the lowest dynamic compression set over 100,000 cycles. In comparison, these are better multidensity combinations than the others tested to use as therapeutic orthoses in footwear for diabetic patients.

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