title: Immediate Effects of Clock-Turn Strategy on the Pattern and Performance of Narrow Turning in Persons With Parkinson Disease.
abstract: OBJECTIVE
  Turning difficulty is common in people with Parkinson disease (PD). The clock-turn strategy is a cognitive movement strategy to improve turning performance in people with PD despite its effects are unverified. Therefore, this study aimed to investigate the effects of the clock-turn strategy on the pattern of turning steps, turning performance, and freezing of gait during a narrow turning, and how these effects were influenced by concurrent performance of a cognitive task (dual task).
  
  
  METHODS
  Twenty-five people with PD were randomly assigned to the clock-turn or usual-turn group. Participants performed the Timed Up and Go test with and without concurrent cognitive task during the medication OFF period. The clock-turn group performed the Timed Up and Go test using the clock-turn strategy, whereas participants in the usual-turn group performed in their usual manner. Measurements were taken during the 180° turn of the Timed Up and Go test. The pattern of turning steps was evaluated by step time variability and step time asymmetry. Turning performance was evaluated by turning time and number of turning steps. The number and duration of freezing of gait were calculated by video review.
  
  
  RESULTS
  The clock-turn group had lower step time variability and step time asymmetry than the usual-turn group. Furthermore, the clock-turn group turned faster with fewer freezing of gait episodes than the usual-turn group. Dual task increased the step time variability and step time asymmetry in both groups but did not affect turning performance and freezing severity.
  
  
  CONCLUSIONS
  The clock-turn strategy reduces turning time and freezing of gait during turning, probably by lowering step time variability and asymmetry. Dual task compromises the effects of the clock-turn strategy, suggesting a competition for attentional resources.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A141).
authors: School and Graduate Institute of Physical Therapy (W-C.Y., W-L.H., K-W.L.), College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Neurology (R-M.W.), National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan; and Department of Physical Therapy (K-W.L.), Tzu Chi University, Hualien, Taiwan.
authors: Wen-Chieh
authors: WC
authors: Yang
authors: Wei-Li
authors: WL
authors: Hsu
authors: Ruey-Meei
authors: RM
authors: Wu
authors: Kwan-Hwa
authors: KH
authors: Lin
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D009048:Motor Skills; D019957:Motor Skills Disorders / Q000209:etiology / Q000534:rehabilitation*; D009068:Movement; D010300:Parkinson Disease / Q000150:complications / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D013647:Task Performance and Analysis