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Table 1 Physiological constraints in Parkinson’s disease that affect turning. The table lists exercise principles, examples of exercises, and progressions of difficulty designed to improve turning ability

From: TURN-IT: a novel turning intervention program to improve quality of turning in daily life in people with Parkinson’s disease

Constraints

Exercise principles/Actions

Exercise examples

Exercise progressions

Narrow base of support

Widen base of support with walking and turning at varying turn angles and speeds

Avoiding crossover with sideways walking

Walking with turning at various degrees

Figure 8 s around cones

Decreasing external cues (visual and verbal) for foot placement, increased speed

Rigidity

Decrease axial rigidity through axial mobility: improving trunk/pelvis flexibility

Promote top-down approach for turning: eyes/head/trunk/pelvis coordination

Axial mobility exercises: trunk rotation, pelvic tilts

Segmental turning

Progressing from mat table to floor, improve form and speed

Bradykinesia

Weight shifting with large APAs

Use of metronome to increase speed of movement

Clock turns

Rocking turns

Lateral stepping over hurdles

Decreasing UE support, decreasing visual input with dribbling glasses, increasing speed, dual task

Impaired sensory integration

Kinesthetic awareness on body movement and foot placement

Decrease visual dependence

Turning at various angles, navigation around obstacles and narrow spaces

Decreasing UE support, decreasing external cues (visual and verbal), adding hand and arm weights, decreasing visual input with dribbling glasses

Reduced attention

Dual tasks during mobility and turning exercises

Random callout on turns

Adding cognitive dual-task activities Inhibition Go-No Go

Increased complexity of exercise, increased speed

Inflexible set-switching

Difficulty with functional mobility including sequencing

Rolling and bed mobility

Sit to stand + turn

Decreasing visual cues, increased speed

  1.  UE Upper Extremity