University Place

Meeting Wisconsinites with Parkinson Disease Where They Are

– Welcome everyone to Wednesday Nite @ the Lab.

I’m Tom Zinnen.

I work here at the UW-Madison Biotechnology Center.

I also work for the Division of Extension and Wisconsin 4-H.

And on behalf of those folks and our other co-organizers, PBS Wisconsin, the Wisconsin Alumni Association, and the UW-Madison Science Alliance, thanks again for coming to Wednesday Nite @ the Lab.

We do this every Wednesday night, 50 times a year.

Tonight, it’s my pleasure to introduce to you Kristen Pickett of the Department of Kinesiology.

Kristen was born in Darlington, Wisconsin in Lafayette County.

And she went to high school in Darlington, Wisconsin in Lafayette County.

And then she went to UW-Platteville and majored in biology, which is what I did.

What year did you graduate?

– 2002, so close.

[all laughing]

– Different millennium.

Okay, and then she went to the University of Minnesota to get her PhD in kinesiology.

She postdoced at Washington University in St. Louis, and then she came here to be on the faculty in the Department of Kinesiology.

And tonight, she’s gonna talk with us about “Meeting Wisconsinites with Parkinson Disease “Where They Are.”

Would you please join me in welcoming Kristen Pickett to Wednesday Nite @ the Lab?

[audience applauding]

– Thank you, Tom.

All right, so I haven’t asked permission for this yet, but my hope is that tonight can just be an introduction to my lab and what we do.

And then once we go out and meet some people with Parkinson disease, where they are, we can come back and tell you a little bit about what we found and how amazingly successful we are.

So hopefully tonight is the introduction.

Just right now so that I don’t forget, I brought one of my wonderful graduate students with me.

So this is Abby.

Abby is going to do some gait demonstrations for us later.

You have a high degree of certainty, 80%, that she’s not gonna fall down.

While we are interested in falls, she’s promised we’re not gonna demo them tonight.

So the plan is, if it’s all right, we’ll talk a little bit about Parkinson disease, a little bit about the things that we do in the lab, our areas of interest,

and then we brought part of the lab with us.

So towards the end, Abby will give us demonstration of what we use, a piece of our equipment that we take out in the community with us.

We’ll talk a little bit about the measures that we get from this device, why we use this, how we use this.

So what I wanna talk about a little bit is some of our work that we do with Parkinson disease.

I’m gonna spend just a couple minutes talking a little bit about what PD is.

Some of you may be very familiar with this, some of you less so.

So just a quick, brief overview.

So Parkinson disease is a movement disorder with hypokinetic features, which means things tend to get smaller.

Movements get smaller, movements get slower.

Things like walking instead of nice long strides, people start to take shorter and eventually even shuffling strides.

And sometimes in some cases, even begin to do something called freezing,

which is when you wanna take that next step, and you can see they wanna take that next step, but they can’t quite make it happen.

So that’s called freezing of gait.

And that can happen in the upper limbs.

It can happen with speech.

But it’s one of the features of PD.

And unfortunately, we have completely failed with Parkinson disease.

We don’t have a cure.

We have some things that can help,

which we’re gonna talk a little bit about tonight.

But it is a progressive and degenerative disorder.

So as you continue to live with it, all of those things get a little bit worse.

And if you work with a neurologist

who works with people with Parkinson disease, one of their favorite sayings is,

“If you’ve met a person with Parkinson disease, “you’ve met a person with Parkinson disease.”

So it presents very differently for everyone.

So some people will walk in and you know right away that they have Parkinson disease

because they have a very defined tremor.

Or when you sit and talk to them,

their hand tremors the whole time.

Some people, you can sit and talk to them for two hours, and they are steady as a rock.

Probably more steady than me with all the caffeine.

No shake, no tremor, no strange movements.

But they’re very slow.

Slow when they talk, slow when they walk, slow when they reach for things.

So individuals present very, very differently, which also is one of the reasons why it’s very hard to diagnose.

So the best neurologists in the world, those who specialize in Parkinson disease, are right 80% of the time,

which means even if you’re very, very good and you’ve seen this a lot of times, you’re still gonna get it two out of every ten wrong.

So we’re working on diagnosing it better.

We’re working on treating it better, but there’s a lot of things that we still don’t understand.

The way Parkinson disease has been classically diagnosed is we know there are four sort of

typical, cardinal symptoms.

And those four symptoms are tremor, so specifically it’s a rest tremor.

So it doesn’t happen when I’m reaching for things as much as when I’m just sitting and talking to you, my hand shakes.

Sometimes you might not even notice that it’s happening.

But there’s a tremor.

It can happen in your hand.

It can happen in your leg, in your face, in your head.

Rigidity, so rigidity means if you try to completely relax, try to be as at rest as you can and I move your limb,

you fight me the whole time.

Not on purpose, but you just can’t completely relax that limb.

Bradykinesia and akinesia, I’m sure, you come to these all the time so you know this, science and medicine, we just like big words.

Bradykinesia just means that you move slow.

That’s all that means.

So bradykinesia is a slowness of movement.

Akinesia is an absence of movement.

So you could notice that in slower speech patterns.

You can notice that in slower walking, slower reaching to a target.

Sometimes slower processing, and we’ll talk about that in just a second.

And then the fourth symptom is postural instability.

Sometimes that means the first thing that actually led you to the doctor is that you fell.

So you’re at home,

you’re moving around in your kitchen or your bathroom, and your toe caught, and you fell to the ground.

And that’s the first time you get there, and then they notice that you’re a little bit more rigid, or there’s a little shake that’s happening, just on one side of your body, and it’s subtle, but it’s there.

So these four cardinal symptoms are sort of the classic motor symptoms that we look at with PD.

If you have three of the four of these, we call it Parkinson disease.

If you have two or less, we call it parkinsonism, which means it’s like it.

So some of you may be familiar with something like essential tremor.

So essential tremor looks a lot like Parkinson disease, and sometimes it’s even worse than Parkinson disease.

That tremor can be pretty profound.

But you don’t have any of those other symptoms.

The up and down side to that, it’s a terrible day when you’re told you have Parkinson disease, but there are some things we can do for it.

For a lot of the isms, there aren’t.

So it’s a bad and good thing to have a diagnosis once you start to see those symptoms present.

For a long time, the kind of classic definition of Parkinson disease and what everybody knows, is that you have that shake.

And it’s a very, that tremor looks very specific.

We call it a pill roll tremor.

If you slow it down, the thumb sort of tremors in one direction, and rest of the hand tremors kind of separately.

We know exactly the frequency that that tremor happens at.

We know what a Parkinson tremor looks like.

We’ve focused on all of these movement components because it’s a movement disorder.

But as it turns it out, there’s a lot of other things.

And as we do a better job

of a very novel scientific idea,

which is to listen to the people

who actually have the disorder,

as we’ve done a better job of that, we’ve learned that there’s a lot of things that may in fact actually be more impactful than those four other symptoms.

So this is a few of them, just to throw a few out there.

So a lot of individuals with Parkinson disease have difficulty swallowing.

And sometimes there’s specific foods in fact that are most difficult, things like rice.

And that causes you to aspirate

or to choke on that food.

And as it turns out, the most common cause of death for individuals with Parkinson disease is that, it’s aspirating on food.

A masked face or hypomimia.

We live here in the Midwest,

so we all have our Midwest stoic presentation.

This is the clinical version of that.

So people with Parkinson Disease have what’s called a very flat affect.

If you are ever looking to be entertained, you can watch a young, training to be clinical student experience their first clinical experience with an individual with Parkinson disease.

Because we all wanna be funny and well-liked, and when you tell somebody something funny or make a joke about the weather and their response is this.

And when they’re sad their response is this.

What that causes students to do is make bigger things happen until they are animatedly trying to make the person react, and they just don’t.

That’s part of the disorder.

So we call it a poker face or PD masked face.

What goes along with that is a decreased blink rate.

As soon as somebody tells you that one of the symptoms is a decreased blink rate, right now you’re already thinking about how many times you blink.

So if we watch a person with Parkinson disease, they tend to blink less than you and I do, which can cause things like dry eyes.

Hypophonic speech or hypomimia.

This is weak, monotone, and kind of breathy speech.

So it becomes harder to hear them.

Again, this is one of those if you listen to the people with PD and their partners, a lot of times the person with PD will tell you that their spouse is losing their hearing.

And it’s so annoying that

they won’t get their hearing tested.

They need a hearing aid and they won’t get it.

As it turns out, it’s actually the person with PD whose voice isn’t modulating the way it used to.

But that is causing the spouse to say “huh” a lot.

Deficits in proprioception.

So proprioception is how I know where my body is in space when I’m moving around.

So without looking, I don’t have to worry about hitting the podium.

I know where my hand is.

I know where that is.

I don’t need to constantly use vision to size them up.

People with PD have decreased proprioception.

And then those gait pieces that we talked about.

So the shuffling, the sometimes freezing.

There’s different types of freezing we can talk about later.

All of those things are still motor things, things that involve the motor system, whether it’s moving or swallowing or speaking.

As it turns out, there’s a whole lot of non-motor components to Parkinson disease that we haven’t put a lot of emphasis on.

But especially from something

like a occupational therapy standpoint, that could have a very big effect in your everyday life.

So things like cognitive and mood disturbances, we used to think a unlucky few people were diagnosed with both Parkinson disease and Alzheimer disease.

It turns out that there’s something called Lewy body dementia, which individuals with Parkinson disease are more likely to be affected with.

And what that causes is dementia-like symptoms.

So now you have both movement and motor presentations as well as cognitive presentations.

It turns out once we again, started doing that novel task of listening to people, individuals with Parkinson disease

actually have gut-related symptoms

that onset way earlier in life,

things like diverticulitis,

difficulty with bowel

and bladder control and function.

Ulcers, there’s been some recent evidence that ulcers are related to it.

And the gut-related bacteria are actually different in an individual with PD as well.

So all of these things, you wouldn’t know unless you listen to somebody talk about what happened 20 years before they were diagnosed to know that these things happened earlier in life.

Anosmia, similar to AD, people with PD often lose their sense of smell very early in life.

Sleep disturbances are very common, and again, on the partner side of this, sometimes it’s disruption in sleep.

You just can’t get to sleep as well, which you can imagine, if you’re having a tremor or you’re very rigid or you have a hard time getting out of bed, all of those things could be affected.

Individuals with PD actually also have much more vivid dreams, and they tend to actively act out those dreams.

So we actually had a participant they were talking to a couple weeks ago whose wife, a few times, has had to sort of flee the bed

because he’s acting out a dream, and he is actively punching what he sees in his dream as a threat, but which is really a pillow or the bureau next to their bed, or unfortunately, his wife.

And that’s because when you should in fact be paralyzed during a dream state,

they are physically, actually acting things out.

Sometimes with verbal responses, sometimes with motor responses, but a lot of big physical things can happen when they shouldn’t be happening.

And then last but not least, depression, and there have been numerous news stories in the last five years about individuals with PD, extreme depression causing things like suicide and suicidality.

So we now know that this is something we should be looking for related to the diagnosis of PD.

So what do we do about all this?

The traditional treatment options are pharmacological.

So we know that there’s a medication.

Specifically what’s going on with Parkinson disease is related to the neurotransmitter dopamine.

So if we could just get the person to have more dopamine, we could fix this.

There’s a problem with your brain

that we can’t just give you dopamine.

There’s something called your blood-brain barrier that won’t allow dopamine to just be introduced to the brain.

So we can give you the precursor to dopamine and change those dopamine levels in the brain.

That medication unfortunately is also toxic to your body.

So if any of you have seen Michael J. Fox in the last 5 to 10 years, that thing he does, those movements, that’s not actually Parkinson disease.

That’s the medication.

And if he goes off the medication,

all of those movements go away.

But all of his PD symptoms come back in full force.

So you have to make a choice at some point in time, debilitating, dance-like movements, which are called dyskinesias, or debilitating tremor or rigidity so bad that you can’t move.

You’re stuck in a chair, or you’re stuck in bed.

And so those are the choices.

And that medication has a cumulative effect.

So the longer you’re on it, the worse it is on you.

So we won’t get into all of the different diagnoses of PD right now.

We can talk about that later.

But if you’re diagnosed with Parkinson disease at 42 years of age,

the first course of treatment is medication.

You can imagine by the time you’re 60, already the cumulative effect is pretty severe.

So the earlier you’re diagnosed,

the earlier you’re on the medication, the worse those effects become over time.

In the last 20 years or so, the development and then improvement of something called deep brain stimulation has helped individuals with PD.

So deep brain stimulation is, there’s an implant that’s done similar to a pacemaker in your chest.

There’s a lead that runs up your carotid artery, and then we drill a hole in your brain and introduce a little lead.

And that stimulator helps to affect thesort of bypass what’s happening

with lack of dopamine that’s there in the brain.

That stimulator can be turned up and down.

It can be graded as the disease progresses.

But it is pretty major brain surgery to have a lead implanted in your brain.

That said, it has developed, it has come a long ways since the very first iterations of it.

It is wildly successful for a large number of people.

So in that instance of the 42-year-old who’s diagnosed with PD, a deep brain stimulator may be one way to keep that introduction of medication both lower, and keep that medication at that same level longer than having to continuously increase the medication as quickly.

Then there’s all sorts of things

from a clinical perspective we can do.

So an occupational therapist,

if we know you have gait problems,

can come into your home

and work with you on things such as not having a throw rug.

This is a great place to catch your toe if you shuffle your feet and fall.

So we can approach those types of things.

A physical therapist can work on things like strengthening and walking and making sure that you’re attending to the right things when you’re walking so that you don’t fall.

There’s a number of speech-related things as well as, so a speech language pathologist can work on the speaking part,

but also on the swallowing part.

And the last piece that we’re gonna move on towards is exercise.

So I’m not here to tell you about results of exercise-related study for Parkinson disease, ’cause we’re done with that.

It works.

Parkinson disease individuals, you, me, exercise is good.

We’re past data on that.

So my lab isn’t focused on showing that exercise is good.

There’s a whole bunch of things that we know exercise is good for.

You fall less.

You’re happier.

You move more.

You eat better, you sleep better.

Just about anything you can think of going wrong, we can slightly improve with some forms of exercise.

So that’s great.

In my mind, the goal of my lab

isn’t to sell you on that fact anymore.

There are some issues with exercise.

Effects of exercise are often specific to the exercises that you’re doing.

So if I run on a treadmill every day, that’s not making me stronger.

And if I lift weights every day,

that’s not improving my cardiovascular function.

Both do actually to a little effect, but not hugely.

So it’s specific to the type of the training you’re doing.

And then no different for people with PD than for you and I.

When you stop exercising, it stops working.

So you have to keep doing those things.

So the challenges are, how can we keep people active, keep people moving, keep people engaged, and do that for the long term.

However, full stop, and I’m not a clinician, but exercise isn’t a replacement for that medication.

So it’s again, not the job of my lab or a physical therapist or an exercise interventionalist to say, “You know what, why don’t we take you off “your dopamine medication and instead, we’ll go for a run.”

That’s not what it does.

The two things work together.

So you’re on your medication, we can keep you at that same level of medication longer by exercising.

But it’s not a replacement, one for the other.

So my argument toward that whole you gotta keep doing it and it’s specific to what you’re doing, is that we need to find things that interest you.

I hate running on a treadmill.

If you gave me a choice between living an extra 20 years and running on a treadmill every day, fine.

Whatever my, whatever was going to die, I will die 20 years earlier.

That is not, not doing it.

I’ll go for a walk,

I’ll go skiing.

I’ll play basketball.

I’ll go swimming.

But I am not running on a treadmill.

So to me, the goal for us is to figure out what can we do to get people engaged and to keep them engaged in the long term.

And so that’s what we’re gonna focus on tonight and what my lab is focused on.

So we’ve looked at a bunch of non-traditional things.

If treadmill running is harder to get people to buy into, what could we do that is better?

What’s more exciting?

What’s more interesting?

So people have started to look at

some alternative types of exercise

or alternative types of movement.

So Tai Chi, there was a pretty big study a few years ago that showed Tai Chi is effective in helping people with Parkinson disease to not fall.

So if you’re more aware of your body, you’re more aware of how you move,

of where that center of balance is, maybe you’re less like to hit the floor because you can have a better understanding of how to keep your feet under you.

Boxing, hitting a punching bag may not be the first thing that comes to your mind in a way to fight a neurodegenerative movement disorder.

As it turns out, boxing is really exciting.

And we have a boxing group right here in Madison that is always full, specifically for people with Parkinson disease.

There’s different components of that that you can look at.

It’s a very physical task.

If you’ve ever tried hitting a punching bag for just a minute, it’s hard.

It’s a difficult task to do.

But it also lets you do things like relieve stress.

It lets you do something that’s both cardiovascularly and muscularly related at the same time.

So boxing has had a lot of positive effect.

And dance.

And when I was at Wash U, I had the fortune to work with Gammon Earhart, who was one of the people who introduced the idea of tango dancing for people with Parkinson disease.

So before we see these folks dance, why tango?

So the reason that they first looked at it is that tango specifically approaches a bunch of things that are difficult for people with Parkinson disease.

So one of the things we wanna focus on with people with PD is taking those nice long steps.

Well, that’s one of the focus of tango.

You need to take long steps as you move through that dance space.

It’s built into the intervention, if you will.

People with PD also have a hard time getting started, that whole freezing piece.

Tango has music with a nice hard beat to it.

So that’s built into it.

It’s also improv.

So there’s no set steps in tango.

You do whatever comes next.

You learn a series of moves,

and then whatever the leader does, you do next.

We also know, and as Abby will demonstrate in a little bit, one of the things we look at in the lab is backward walking.

And just for all of us.

I’m way more likely to fall doing this than I am doing this.

So tango has that built in, backwards stepping, turning.

And also during all of these, and you will see these two folks here dance in just a second, you have a partner.

So if I do lose my balance, I’ve got a partner right there who can give me just a little extra help to not fall.

I will also argue that the other piece of this is that there is a huge social component.

There’s no way to come to a tango dance class and not engage those around you.

So you also have that accountability.

You have that person asking you, “Hey, how are you?

“I know you fell the other day, is your knee any better?

“How are the grandkids?”

So there’s that social aspect, which we’ll get into as well.

[tango music playing]

We run a tango class here in town

out at UW Sports Med.

So these are two folks from our tango class.

[tango music playing]

– Man: Ah, very good one.

– So the question that we focused on in my lab, the next thing is, what do we do

to engage those who aren’t already engaged?

Madison is great.

We have, I don’t remember what the last count is, 13 different programs I think for people with Parkinson disease.

That’s amazing.

You wanna box, we’ve got a boxing class.

You wanna row, we’ve got a rowing class.

We’ve got a walking group.

We’ve got, there’s a fitness class out at the fitness center on the West Side.

There’s a fitness class on the East Side.

There’s the BIG program.

You wanna move in some specific way, we’ve got it.

And that’s great.

The problem is, what do we do for all those folks that aren’t currently engaged?

So group one is the not a fan of exercise.

Some of you may identify with that idea.

I’m not gonna sweat.

I’m definitely not gonna sweat in front of people.

No, I’m fine.

Don’t really need exercise.

Exercise is overrated.

So what do we do to get exercise

to those people who are not interested in the E word?

So what we do in the lab is we remove the E word.

We find tasks for people to do

to stay physically active without calling it exercise.

And the intervention that we’re currently working on is glass blowing.

So I don’t know how many of you have seen glass blowing before, so this isn’t jewelry glass blowing.

This is make a vase, make a cup glass blowing.

So you reach this long bar into a vat of liquid hot glass, and you bring the glass out, and then you use tools to shape the glass.

And we are doing that with people

with the movement disorder,

which probably isn’t a sane idea, but we’re trying it, so it’s gonna be fine. [audience laughing] So what we can do is instrument that lab space so that we can look at how people physically move, and how those movements change the way that they act both before and after.

So this is just an example of one way that we can measure those motions

and look at how they change during the duration of that craft, that technique they’re learning.

And what we’re working on currently, we’ve actually piloted this.

The class is ready to go.

We’ll be rolling this out as an intervention later in the spring semester.

And we’re now moving it on to other craft disciplines.

So what does this give you?

Well, it gives you gross motor.

You have to pick up a big pipe.

You have to walk around with it.

There’s gait, there’s balance,

there’s getting up and down from a chair.

There’s taking a bunch of steps

while you’re in that space.

And there’s fine motor.

So we’ve taken this same idea, this same protocol and we’ve moved it into other craft spaces.

So we have a full-sized loom.

We have a woodworking horse that you sit on.

It’s not a saw horse, but it’s a horse.

– Man: Shaving horse. – Shaving horse, thank you.

Glad you sat up front.

We have a metal-working area.

So you heat metal and you pound it

into the shapes that you want to pound it into.

And then we have folks throw pots.

Not throw pots, but pottery, ceramic type of throw pots.

So all of those things have the same components, big gross motor and small fine motor.

You have to be up and move around.

And we build those into it.

And the other thing that we do is we build in the fact that our occupational therapy students interact with the folks while they do this.

So it makes it not just a physical task, but also a social task.

Group two, some people don’t exercise because they genuinely can’t.

Whether that’s because they can’t afford to go take that boxing class

or they don’t have money to get on the bus, or they’re 80 years old and they’re still working a full-time job.

They don’t have access to those things.

And being from Darlington,

no matter how much money you have,

there are not 13 Parkinson disease classes in Darlington.

There’s not one Parkinson disease class in Darlington.

So the question is, what do we do for those folks who can’t come do those things,

who don’t have the luxuries that we have here?

And our answer to that is we go to them.

The downside to this is that it means a lot of time not in the lab.

It means that we have a family van

with a trailer hitch on the back and a trailer that we put in a picture of.

But we take a bike and we put it in their house.

Bikes are great.

Everybody’s really excited when you buy your new state-of-the-art recumbent bike.

And it is a great thing.

For two weeks.

[audience laughing]

And then mail, when you bring the mail in, it sits really nicely in that little rest up front.

Clothes basket fits perfectly on the big seat.

A hanger is really great on the bars, and pretty soon, it becomes a very fancy clothes, laundry device in your living room.

And we know that ahead of time.

So what we do that’s a little bit different is we actually set them up with a Skype account.

And for those folks that don’t have the internet, we bring them the internet as well

via a my-fi device, and we bike with them.

So when they’re on the bike, one of my students or myself is on the bike.

The rules are that you are not allowed to just sit and eat Cheetos while the person is on the bike and you, “Woo, you should go faster.

“Ah, we’ve only got 10 minutes left, go more.”

You have to bike with them.

So you are engaging in exercise together.

We sort of have a protocol to help them go faster, to go more, or to continue to press the exercise a little bit harder.

But you’re doing those two things together.

Both of you are progressing at the same time.

Both of you are out of breath at the same time.

And we try to keep the same people together for the most part.

So you’re also building some rapport with that person.

So while the first few interactions are: “So it’s cold, is it cold there?”

[audience chuckling]

“Do you like the Brewers?”

Over time, that really changes.

And about two weeks into it, you start to develop that bond, and our individuals with PD really become attached to

and respond to the individuals that they’re cycling with.

And it matters.

It matters to them.

For a lot of the folks that we’re working with right now, this is primarily currently being introduced in rural settings.

They may not see other people than their spouses for long periods of time.

So sometimes we’re it.

And as a few of you may be able to relate to, you don’t wanna hear that same story anymore.

You’ve been married for 50 years,

and you heard that story about that bus ride when you were 30, and it’s not fun anymore.

But our OT students, we haven’t heard that story yet.

And we will listen to that story

and be interested in that story genuinely, and talk about why you decided to put in cable TV in the basement.

And your partner doesn’t want to hear that anymore.

So it’s not just the biking.

It’s also this, “I’ve got somebody who cares “and wants to talk to me.”

And so that piece is what we’re trying to build into the intervention,

and what we’re introducing to these folks.

So this is a video of why we pay attention to the things we do.

This gentleman actually has very severe Parkinson disease.

He’s unable to walk without falling.

So logically, the first thing you’d wanna do is put him on a bike, which is what they did, in the middle of a traffic-filled street in Germany.

And despite the fact that he can’t stand up, he can ride a bike like a champ.

We pick cycling because it’s a closed chain activity.

So where the left foot goes relates to where the right foot goes, and it happens in a pattern.

If one side has a deficit, it may in fact be okay because the other side can help it through.

People with PD are typically able to exercise on a recumbent bike fairly comfortably and for long periods of time.

And then the last group are those who are ready to go.

There’s no reason to ignore those folks who want exercise.

So we do sponsor a tango group here in town.

There’s a lot of things through the American Parkinson Disease Association here in the Madison area, lots of things that you can do, that they can do

to help keep folks active.

And always options to find things that are out there.

And a lot of research options for those who are trying to find out what would be most effective or what would fit best for them.

So this is a picture of that tango class that we run out on the West Side.

Again, for those folks who are ready to roll, what we try to do is yes, you can bring your own dance partner, and we’re fine with it if you wanna bring your own dance partner.

But we also partner these folks up with our people.

So they dance with our occupational therapy students, physical therapy students, kinesiology undergrads, and they get a chance to get to know somebody and to dance both what we call the leader, rather than the male and female roles, we call it leader and follower.

And everybody gets to do a little bit of both.

So you do walking forward as well as walking backwards.

And you have to learn to communicate with people as they go.

We’ve had people who are not altogether ambulatory and people with cognitive issues

who really just get there and just move for the time that you’re there, but you move with a partner.

And so it’s something and they’re engaged, and they have somebody to talk to.

So what are we doing to answer these questions?

Well, I’m all for this gait mat,

and we’re gonna show you in just a second how this works.

We also think it’s really important not just to look at purely clinical measures, but also to look at functionally relevant measures.

So we built the kitchen.

And similar to what we’re gonna look at in just a second on this gait mat,

there’s a fancy gait mat in the floor of this kitchen.

So I can see things like how long are your strides and how wide apart are your feet

and how well do you distribute the weight between your two feet when you make muffins and soup and cut and core an apple?

And importantly, when you open the refrigerator and take those two backwards steps

after you get the apple out of the refrigerator.

So this space allows us to look at those functional measures and then the mat, which we’ll play with right now, which I’ve danced on and put a wrinkle in, the mat allows us to take measurements of what we call spatial-temporal.

So time and distance measurements live.

So I get direct feedback as you walk.

So Abby is going to demonstrate for us as I tell you about these things.

So we’ll have Abby just do a walk down the mat here.

So you see right away, as soon as she passes down the mat, if I’m in a clinic right now, I can look at things such as asymmetry.

So here on this output, we can see things, the green and purple numbers are left and right.

So I can compare left and right sides of her steps.

So is her left stride as long as her right stride?

If her left stride is shorter, that tells me she’s not pushing off as hard with that left leg.

So that could tell me something like Parkinson disease, maybe we have an asymmetry.

Maybe it’s more in her actual body structure.

So maybe there’s more of an orthopedic issue there.

It could be a hip issue.

It could be a knee problem.

We can see things like if you toe in or toe out.

Now Abby’s gonna start to get very worried about what her gait is telling all of you.

We can also just see things like speed.

So how fast does she walk?

And, what she just did is just normal forward walking.

If we give her a task such as naming all the men’s names that you can

that start with the letter C, will you walk?

– Collin, Connor.

[audience laughing]

– I’m pretty sure Abby’s parents are in the room, so I’m sure they’re very impressed right now.

[audience laughing]

So without having any training in gait analysis, well one, you saw her pause

as she’s trying to think about something.

So we specifically tell people when they walk on the mat, even if you can’t think of the next thing, keep walking.

But when you do that, you can see for example, the first two steps to the third step, there’s a longer stride there,

and then a definitively shorter stride between three and four.

That’s when she’s thinking about something.

So what we know from the literature is if you want to fall when you walk down a hallway, try to do a couple things at the same time.

[audience chuckling]

Or have the phone ring when you’re on your way to the bathroom and also somebody’s yelling for you to bring them something.

When all of those things, which are called dual tasking happen, it changes the way you walk.

And we can measure that using this directly from their normal walking to their dual task walking.

Another thing that we do is really try to challenge the gait system.

So these two things are relatively speaking, normal walking, regular forward walking, dual tasking.

So something that we can do to really make this task more difficult is ask them to walk in tandem.

So tandem walking is like you’re on a balance beam or a tightrope.

And the reason that this challenges your system is that it takes away your base of support.

So the whole balance just means

that I keep my center of gravity over top of my base of support.

My base of support are basically if I draw a rectangle around my feet, and my center of gravity is somewhere just below my belly button where my two fingers would meet right now if they could.

All if have to do to not fall down is keep this above that.

All I have to do to make that task way harder is narrow your base of support massively and tell you to walk forward at the same time.

So now we’ll ask Abby to do that.

Okay, not bad, not bad.

[Abby laughing]

So we can look at just pure velocity during this.

We can look at how much you wobble.

For a lot of individuals, what happens is as you’re doing that, you actually misstep and have to correct and keep going.

We can measure all of those components.

How far is that misstep off of the straight line?

How may times do you do it?

Can you just pull that one back?

And then the last one that we’ll demo, and we do this with individuals with pathology, but we ask them to walk backwards.

Typically, we have somebody spotting them while they’re doing this.

Tonight, Abby’s gonna do it without a net, and it’s gonna be fine.

[audience laughing]

[imitates drum roll]

[Kristen laughing]

So that seems like a silly task.

How often do you walk backwards?

What scientific point is there really to having somebody walk backwards?

Well, the whole idea there is that it is a novel task.

It’s not different than when you’re walking and carrying a laundry basket

or trying to carry a grandchild on one arm and talking on the phone.

It’s a novel task that is still gait, that cyclical gait pattern should still be there.

But it’s something you’re not used to doing.

So sometimes things that don’t come out during normal forward walking, will come out during backwards walking because we are challenging that system more during that thing

than we are during any other.

So we’ll leave the gait mat here for now, and when we get all done, if anybody’s interested in coming up and trying it out, you can certainly do so.

So just to wrap things up, there’s the picture of the trailer.

So the whole idea with what we’re doing, it would be, in my opinion, unfair for us to say that we should reach out to communities who have a difficult time accessing research and accessing clinical care if we then say, “Come and be in our study, all you have to do “is come to the university.”

So we are working right now on, we have a study that we’re currently going out into the community.

We’ve been up to Hayward.

We go to Pepin.

We’ve been up to here and we’ve been over here.

We go down to Shullsburg.

We go to Portage and to New Glarus.

And we put all of this equipment in that and we drive there.

In the Madison area, if you’ve been in a research study, you’ve probably been in 10 research studies.

We are finishing up a data collection right now on a rural yoga intervention we’re doing just for healthy aging.

So not for individuals with Parkinson disease.

And the sample that we looked at, it’s over 95% of the people who have never been

in any type of research study ever.

So it’s not a thing you do in Shullsburg.

The only way to get them to do this is if we go to them.

And I’m from there, we’re not coming here.

We don’t even really like Madison people all that much.

[audience chuckling]

We’ll tolerate, but we can deal with you if you’ll come to us.

So the whole idea is, we can make this more accessible, and I think we can get to a whole different group of people if we’re willing to go to them.

So in conclusion, we already know

that exercise is good for people with Parkinson disease.

The question is, what do we do to get it to those folks who right now don’t have access?

I’m introducing some of the measures that we use to look at those things, and would love to come back and tell you about the things that we’re finding as we go through all of this.

Rural and urban folks

are dramatically underserved right now, and that is overwhelmingly true

for those with Parkinson disease.

They are already not a mobile group of people.

It doesn’t get any better when you put them in populations that don’t have readily accessible healthcare to start with, but definitely not easy access to the university system.

So we’re doing what we can to help those folks find exercise in whatever way that we can.

And just a quick thank you to all the folks in my current lab, and the folks from Wash U who contributed to some of that data that we talked about early on.

So I will gladly take any questions that you have, and then whoever wants to come play on the gait mat, we’ll set you up, and we will spot

when you walk on the gait mat, so.

[audience applauding]