Training in Varying Environmental Contexts Facilitates Transfer of Improved Gait Performance to New Contexts for Individuals With Parkinson Disease: A Randomized Controlled Trial

  • Ya-Yun Lee
    Corresponding author Ya-Yun Lee, School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Floor 3. No. 17, Xuzhou Rd, Zhongzheng District, Taipei City 10055, Taiwan, R.O.C
    School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan

    Division of Physical Therapy, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Taipei, Taiwan
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  • Chun-Hwei Tai
    Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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  • Beth E. Fisher
    Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA

    Department of Neurology, Division of Movement Disorders, Keck School of Medicine, University of Southern California, Los Angeles, CA
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      To investigate whether varying practice context during gait training could reduce context dependency and facilitate transfer of improved gait performance to a new context.


      A single-blind, parallel-group randomized controlled trial.


      Medical university rehabilitation settings.


      Forty-nine participants with Parkinson disease were recruited and randomized into the constant (CONS) or varied (VARI) context group.


      All participants received 12 sessions of treadmill and over-ground gait training. The CONS group was trained in a constant environmental context throughout the study, whereas the VARI group received training in 2 different contexts in an alternating order.

      Main Outcome Measures

      The primary outcome was gait performance, including velocity, cadence, and stride length. The participants were assessed in the original training context as well as in a novel context at posttest to determine the influence of changed environmental context on gait performance.


      Though both groups improved significantly after training, the CONS group showed greater improvement in stride length than the VARI group when assessed in the original practice context. However, the CONS group showed a decreased velocity and stride length in the novel context, whereas the VARI group maintained their performance.


      Varying practice context could facilitate transfer of improved gait performance to a novel context.


      List of abbreviations:

      5TSTS (5 Times Sit to Stand), ABC (Activities-Specific Balance Confidence), CONS (constant context group), NC (novel context), OC (original practice context), PD (Parkinson disease), TUG (Timed Up and Go), VARI (varied context group)
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