Post-Physical Therapy Extension of In-Home Dynamic Standing Table Use in Parkinson Disease

Axial motor dysfunctions in Parkinson disease (PD) are least responsive to dopaminergic
therapy and incline many patients towards a sedentary lifestyle. This places PD patients at
increased risk for the negative consequences of physical inactivity. When PD patients develop
postural imbalance and gait difficulties, including falls, they are generally referred to
physical therapy for optimal management. Although these patients do benefit from physical
therapy, there is a critical gap in clinical practice on what to do next once the physical
therapy sessions are over. Clinical experience shows that most patients return to a sedentary
lifestyle indicating an urgent need for post-physical therapy in-home physical activity
programs in PD with postural imbalance and gait difficulties to preserve mobility functions.
Recent advances in physical activity research tout non-exercise physical activity approaches
to promote healthy lifestyle modifications. Non-exercise physical activities are activities
of daily living, like cleaning, shopping, and standing, other than intentional exercise. For
PD patients with postural imbalance and gait difficulties, normal upright standing and
weight-shifting (stepping) for longer periods of time may be an ideal form of non-exercise
physical activity. It activates lower extremity muscles and encourages postural activity. To
promote this type of non-exercise physical activity, the study team has developed a sit-stand
desk system that enhances upright standing activity with weight-shifting movements. The
"dynamic standing table" has a tabletop that oscillates in the horizontal plane, which cues
users to make periodic side-to-side body weight shifting adjustments. Dynamic standing would
represent a minimal level of physical activity compared to sitting, which is pervasive in PD
subjects with postural imbalance and gait difficulties. Use of the dynamic standing table can
easily be incorporated with routine desktop activities, such as computer use, reading, or
watching TV and may promote physical activity. Preliminary data shows that patients with
moderate PD can complete sessions of at least 3 hours without significant difficulty and may
have motor and cognitive benefits from using this table. The purpose of this study is to
determine whether a post-physical therapy in-home physical activity program using the dynamic
standing table (as an adjunct to post-physical therapy standard of care—weekly physical
activity group sessions) is effective in sustaining the mobility benefits of physical therapy
compared with post-physical activity standard of care alone in individuals with Parkinson
disease and postural imbalance and gait difficulties. The study team is testing the
exploratory hypothesis that post-physical therapy gains in mobility functions in PD patients
with postural imbalance and gait difficulties will be preserved better with in-home dynamic
standing table use compared to a control group. The incremental addition of the dynamic table
use is expected to more effectively reduce post-physical therapy sedentary behavior compared
to the standard of care alone.

Inclusion Criteria:

- Presence of Parkinson's disease. PD diagnosis following the UK Parkinson's Disease
Society Brain Bank Research Center (UKPDSBRC) clinical diagnostic criteria for PD,
consistent with the typical nigrostriatal denervation pattern on VMAT2.

- Hoehn and Yahr stages 2-4 and/or presence of PIGD features, such as history of (near)
falls, slow gait, and/or freezing of gait.

- Available space to place table in their home (approximately 6 ft x 5 ft area).

Exclusion Criteria:

- Inability to stand or walk without an assistive device.

- History of symptoms in stance that preclude safe and comfortable participation, such
as dizziness and lightheadedness, orthostasis, severe symptomatic leg or back
musculoskeletal pain.

- History of significant symptomatic cardiovascular or pulmonary disease.

- History of active symptomatic rheumatic arthritis.

- History of stroke or other focal brain conditions with residual sensorimotor deficits
interfering with stance functions.

- History of chronic pain syndrome requiring daily narcotic analgesics.

- Evidence of dementia.

- Venous stasis or severe varicosities