Feasibility and acceptability of the spatiotemporal activity modifications (STEAM) program: a Phase I clinical trial in people with mild to moderate Parkinson's disease

The heterogeneous neuropathology, motor-cognitive deficits, and gait impairments in people with Parkinson's disease (PwP) present a need for more tailored rehabilitation. We conducted a preliminary phase I clinical trial to evaluate the feasibility and acceptability of the Spatiotemporal Activity Modification (STEAM) program, developed to address gait modulation deficits and motor-cognitive underpinnings in PwP. STEAM is an exercise-based rehabilitation program using a library of movement patterns to modify spatial features of gait (e.g., coordination of lower limb joints), temporal features of gait (e.g., movement timing and rhythm), or integrated spatiotemporal patterns. Participants with mild-moderate Parkinson's disease were randomized to either an isolated (ISO; n = 21) or coupled (COU; n = 18) STEAM format. In ISO, spatial and temporal instructions were taught separately. In COU, spatiotemporal instructions were taught together. Here we evaluated safety, attrition, adherence, intervention fidelity, perceived exertion, participant feedback, and completion of motor-cognitive and questionnaire-based assessments across ten 90-min STEAM sessions delivered over 3 weeks. No adverse events were reported. Both groups presented low attrition (ISO 4.8%, COU 5.6%), high intervention adherence, and fidelity. Average rates of perceived physical and cognitive exertion (RPE and RPCE) increased from light at the start of class to moderate by the end in ISO and COU, with COU showing higher RPE and RPCE at halftime and the end of the 90-min session. Exit questionnaires indicated high participant satisfaction across groups, and outcome assessment completion rates were high. These findings indicate the feasibility and acceptability of a novel 10-session, 3-week STEAM intervention in PwP.