Outpatient Physical Therapy Intervention in Subjects With Parkinson's Disease Currently Using APOKYN®

Multicenter, outpatient trial to evaluate PT outcomes in subjects diagnosed with PD and
currently using APOKYN. Those subjects who satisfy all eligibility criteria will be
randomized to 2 treatment groups:

1. "APO+" (APOKYN treatment before the PT Intervention Visit) and;

2. "APO-" (APOKYN treatment withheld before the PT Intervention Visit).

The study will have:

- Baseline Assessment Visit(s) - 1 day at Investigator's clinic and PT clinic

- APOKYN Response Verification Visit - 1 day

- PT Intervention Visits - for 6 weeks

- End-of-study Assessment Visit(s) - 1 day at Investigator's clinic and PT clinic All
subjects will participate in a standardized PT intervention. In both treatment groups,
ALL subjects will arrive for the PT Intervention Visit in an "end-of-dose-off" motor
state. The "end-of-dose-off" motor state will be achieved by the subject withholding
his/her carbidopa/levodopa dose and APOKYN dose for at least 3 hours before the PT
Intervention Visit. It is hypothesized that the outcome of PT will be improved when
subjects are in the "on" motor state during PT Intervention visits compared with being
in the "end-of-dose-off" motor state during PT Intervention visits.

Inclusion Criteria:

- Able to understand and sign an Investigational Review Board (IRB)-approved written
informed consent and privacy language (e.g., Health Insurance Portability and
Accountability Act (HIPAA) authorization) as per national regulations before any
study-related procedures are performed.

- Must have a diagnosis of idiopathic PD.

- Adult male or female 18 to 78 years of age, inclusive.

- Currently using APOKYN, per the Package Insert, for at least 4 weeks before Baseline
Assessment Visit(s).

- Currently using carbidopa/levodopa therapy at a steady maintenance dose, representing
a stable treatment regimen in the opinion of the Investigator, for at least 4 weeks
before Baseline Assessment Visit(s).

- Able to walk 50 feet independently (cane permissible) at the Baseline Assessment
Visit.

- Meet all of the following parameters to demonstrate an optimal response to APOKYN at
the APOKYN Response Verification Visit: must be "on" in the opinion of the subject and
investigator within 20 minutes after the APOKYN injection; and have a motor state
improvement of >25% per the Movement Disorder Society (MDS)-UPDRS Motor Score (Part
III), within 20 minutes after the APOKYN injection, as compared to pre-injection.

- Willing and able to comply with scheduled visits, treatment plan, other study-related
procedures, and have available caregiver to provide transportation to clinic visits as
needed.

Exclusion Criteria:

- Received PT targeting Parkinson's disease within 6 months before Baseline Assessment
Visit(s).

- Received any investigational (i.e., unapproved) drug product within the last 30 days
(or 5 half-lives, whichever is longer) before the Baseline Assessment Visit(s).

- Currently taking, or likely to need to take at any time during the course of the
study, any 5HT3 antagonist (i.e., ondansetron, granisetron, dolasetron, palonosetron,
alosetron).

- Currently on or likely to transition to the DUOPA (carbidopa and levodopa enteral
suspension) during the course of the study.

- Has orthostatic hypotension (defined as >30 mmHg decrease in systolic blood pressure
or >15 mmHg decrease in diastolic blood pressure within 2 minutes of standing from a
supine position) at the Baseline Assessment Visit(s), or within 20 minutes following
APOKYN injection at the APOKYN Verification Visit.

- Has a score of 24 or higher on the Modified Physical Performance Test (M-PPT).

- Has a score of 80% or higher on the Activities-specific Balance Confidence Scale
(ABC).

- Has any significant current medical disorder, physical, or mental condition that
would, in the Investigator's opinion, represent a hazard to the subject or prevent the
subject from completing the study.

- Subjects with dementia, in the Investigator's opinion, or subjects with a Montreal
Cognitive Assessment (MoCA) <18.