Rosie Morris

Northumbria University

Running gait assessment is essential for development of technique optimization strategies as well as to inform injury prevention and rehabilitation. Currently, running gait assessment relies on (i) visual assessment, exhibiting subjectivity and limited reliability, or (ii) use of instrumented approaches, which often carry high costs and can be intr...

Background: Turning is a complex measure of gait that accounts for over 50% of daily steps. Traditionally, turning has been measured in a research grade la-boratory setting, however, there is demand for a low-cost and portable solution to measure turning using wearable technology. This study aimed to determine the suitability of a low-cost inertial...

Dopaminergic activity decreases in older adults (OAs) with normal aging and is further reduced in Parkinson’s disease (PD), affecting cortical motor and sensorimotor pathways. Levodopa is the prevailing therapy to counter dopamine loss in PD, though not all PD motor signs improve with levodopa. The purpose of this preliminary study was to explore t...

Various cueing strategies (internal and external) have been used to alleviate gait deficits in Parkinson’s disease (PD). However, it remains unclear which type of cueing strategy is most effective at different disease stages or with more severe walking impairment, such as freezing of gait (FOG). The underlying neural mechanisms of response to cuein...

Visual and cognitive dysfunction are common in Parkinson’s disease and relate to balance and gait impairment, as well as increased falls risk and reduced quality of life. Vision and cognition are interrelated (termed visuo-cognition) which makes intervention complex in people with Parkinson’s (PwP). Non-pharmacological interventions for visuo-cogni...

Objective: To explore experiences of people with Parkinson’s (PwP) in using technology as part of a home-based visuo-cognitive training programme compared to traditional approaches to rehabilitation. Background: Visual and cognitive dysfunction are common in PwP, and relate to mobility impairment and increased falls risk. Novel technologies and mo...

Turning is a common impairment of mobility in people with Parkinson’s disease (PD), which increases freezing of gait (FoG) episodes and has implications for falls risk. Visual cues have been shown to improve general gait characteristics in PD. However, the effects of visual cues on turning deficits in PD remains unclear. We aimed to (i) compare the...

Gait assessment is essential to understand injury prevention mechanisms during running, where high-impact forces can lead to a range of injuries in the lower extremities. Information regarding the running style to increase efficiency and/or selection of the correct running equipment, such as shoe type, can minimize the risk of injury, e.g., matchin...

Background and aim: The study of the neural underpinnings of movement in neurological conditions has traditionally been conducted with associative studies that have used static imaging techniques, such as functional magnetic resonance imaging or positron emission tomography. Previous work correlated movement outcomes with imaging or assessed ass...

Running gait assessment and running shoe recommendation is important for the injury prevention of runners who exhibit different skill-levels and running styles. Traditionally, running gait assessment for shoe recommendation relies upon a combination of trained professionals (e.g., sports-therapists, physiotherapists) and complex equipment such as m...

Eye movements are an important aspect of neurological clinical assessment, as abnormal eye movements can indicate underlying neurological and disease processes. Eye-tracking recordings are also often performed following neurological injury or disease in order to study the underlying neurological mechanisms involved in controlling eye movement. The...

The extent to which the heterogeneity of gait and balance problems in PD may be explained by genetic variation is unknown. Variants in the glucocerebrosidase (GBA) gene are the strongest known genetic risk factor for PD and are associated with greater motor and cognitive severity. However, the impact of GBA variants on comprehensive measures of gai...

Running gait assessment is critical in performance optimization and injury prevention. Traditional approaches to running gait assessment are inhibited by unnatural running environments (e.g., indoor lab), varied assessor (i.e., subjective experience) and high costs with traditional reference standard equipment. Thus, development of valid, reproduce...

Participating in habitual physical activity (HPA) may slow onset of dependency and disability for people with Parkinson’s disease (PwP). While cognitive and physical determinants of HPA are well understood, psychosocial influences are not. This pilot study aimed to identify psychosocial factors associated with HPA to guide future intervention devel...

Purpose Impairments while turning are among the most common mobility impairments in people with Parkinson’s disease (PD). In addition, turning is often a trigger for freezing of gait (FOG) episodes and has implications for falls risk. There are currently limited interventions to ameliorate turning deficit in PD. Visual cues have been shown to impro...

Purpose Walking and eye movement impairments are common in Parkinson’s disease (PD) and are linked to increased falls risk. Visual cues (transverse taped lines on the floor to step over) are a physiotherapy intervention to improve gait in PD, particularly in those who report freezing of gait (FOG). However, the response to visual cues is variable i...

Purpose: Gait characteristics such as turning are commonly impaired in neurological conditions such as Parkinson’s disease and traumatic brain injury (TBI). Traditionally, these characteristics have been measured in a laboratory setting using expensive 3D motion capture or research-grade inertial sensor systems, such as the Opal (APDM Inc., Portlan...

Purpose: Visual and cognitive impairments are common non-motor symptoms (NMS) in people with Parkinson’s (PwP). These NMS impact on balance and gait impairments, leading to reduced quality of life and increased risk of falls, hospitalisation, and mortality. There is limited evidence for rehabilitation of visual or cognitive impairment in PwP, with...

This pilot study will contribute to our understanding of the effects of technological visuo-cognitive training (TVT) in people with Parkinson's and provide preliminary data to support a larger, multi-centre trial. If TVT is demonstrated to be feasible and effective, it presents the possibility of a novel, non-pharmological rehabilitation strategy t...

Running gait assessment for shoe type recommendation to avoid injury often takes place within commercial premises. That is not representative of a natural running environment and may influence normal/usual running characteristics. Typically, assessments are costly and performed by an untrained biomechanist or physiotherapist. Thus, use of a low-cos...

Background Gait disturbance is an early, disabling feature of Parkinson's disease (PD) that is typically refractory to dopaminergic medication. The cortical cholinergic system, originating in the nucleus basalis of Meynert of the basal forebrain, has been implicated. However, it is not known if degeneration in this region relates to a worsening of...

Few exercise interventions practice both gait and balance tasks with cognitive tasks to improve functional mobility in people with PD. We aimed to investigate whether the Agility Boot Camp with Cognitive Challenge (ABC-C), that simultaneously targets both mobility and cognitive function, improves dynamic balance and dual-task gait in individuals wi...

Background Reduced cortical sensorimotor inhibition is associated with mobility and cognitive impairments in people with Parkinson’s disease (PD) and older adults (OAs). However, there is a lack of clarity regarding the relationships among sensorimotor, cognitive, and mobility impairments. The purpose of this study was to determine how cortical sen...

Background: Gait disturbance is an early, cardinal feature of Parkinson’s disease (PD) associated with falls and reduced physical activity. Progression of gait impairment in Parkinson’s disease is not well characterized and a better understanding is imperative to mitigate impairment. Subtle gait impairments progress in early disease despite optimal...

Objective: To characterize response to thalamic deep brain stimulation (DBS) in a patient with medically refractory orthostatic tremor using instrumented measures of tremor and mobility. Background: Orthostatic tremor (OT) is a disabling disorder characterized by a high frequency tremor in the lower limbs upon standing. Electrophysiologic studies...

Objective: Determine whether levodopa replacement or cholinergic augmentation improve automaticity of walking in people with Parkinson's disease (PD). Background: Degradation of dopaminergic striatal mechanisms of motor control in PD may be initially supplemented by increased cognitive control mediated by cortical cholinergic mechanisms. This shif...

Background: Mobility and sensorimotor inhibition impairments are heterogeneous in Parkinson's disease (PD). Genetics may contribute to this heterogeneity since the apolipoprotein (APOE) ε4 allele and glucocerebrosidase (GBA) gene variants have been related to mobility impairments in otherwise healthy older adult (OA) and PD cohorts. The purpose of...

Freezing of gait (FoG) is a brief, episodic absence or marked reduction of forward progression of the feet, despite the intention to walk, that is common in people with Parkinson’s disease (PD). We hypothesized that not only motor, but higher level cognitive and attention areas may be impaired in freezers. In this study, we aimed to characterize di...

Objectives Degradation of striatal dopamine in Parkinson’s disease (PD) may initially be supplemented by increased cognitive control mediated by cholinergic mechanisms. Shift to cognitive control of walking can be quantified by prefrontal cortex (PFC) activation. Levodopa improves certain aspects of gait and worsens others, and cholinergic augmenta...

Freezing of gait (FOG) is common in people with Parkinson’s disease (PD) which is extremely debilitating. One hypothesis for the cause of FOG episodes is impaired cognitive control, however, this is still in debate in the literature. We aimed to assess a comprehensive range of cognitive tests in older adults and people with Parkinson’s with and wit...

Background: Whiplash associated disorder (WAD) is a common musculoskeletal condition that frequently occurs following a road traffic collision. Physiotherapy is often prescribed to help with the symptoms and injuries. Research evidence has demonstrated that acupuncture may be beneficial, but no studies have examined the routine clinical use of acup...

Introduction Mild traumatic brain injury (mTBI) can impact gait, with deficits linked to underlying neural disturbances in cognitive, motor and sensory systems. Gait is complex as it is comprised of multiple characteristics that are sensitive to underlying neural deficits. However, there is currently no clear framework to guide selection of gait ch...

Objective: This study aimed to characterize turning performance and clinical characteristics in people with definite, probable or no Freezing of Gait (FoG) in a cohort of people with Parkinson's disease (PD). Background: FoG is common and debilitating in people with Parkinson's disease (PD). Both clinical decision‐making and pathophysiology resear...

Objective: Gait provides a sensitive measurement for signs of aging and neurodegenerative conditions. Measurement of gait is transitioning from the laboratory environment to the clinic with the use of inertial measurement units, providing a simple and cost-effective assessment tool. However, such assessments first need validation against reference...

Introduction: Gait and balance impairments are cardinal features of Parkinson's disease (PD) that require cognitive input. However, the extent to which specific gait and balance characteristics relate to cognition in PD is unclear. In addition, independent models of gait and balance have not been developed from the same cohort. We aimed to i) deve...

Mobility deficits, including gait disturbance, balance impairments and falls, are common features of Parkinson's disease (PD) that negatively impact quality of life. Mobility deficits respond poorly to dopaminergic medications, indicating a role for additional neurotransmitters. Due to the critical role of cortical input to gait and balance, acetyl...

Background and Purpose: Gait impairments in persons with Parkinson disease (PD) are difficult to manage. Auditory cueing has been shown to be an effective therapy. However, the optimal time to introduce cues with respect to disease stage has not yet been established. This longitudinal study examines the effect of auditory cues on gait characteristi...

Early features of Parkinson's disease (PD) include both motor and cognitive changes, suggesting shared common pathways. A common motor dysfunction is postural instability, a known predictor of falls, which have a major impact on quality of life. Understanding mechanisms of postural dynamics in PD and specifically how they relate to cognitive change...

Objective: This study investigated pre-frontal cortex (PFC) activation while walking in older adults and people with Parkinson’s disease (PD). We specifically examined 1) PFC activation in response to dual-task walking and 2) PFC activation over time. Background: Gait deficits are common in PD, with links to reduced mobility and falls. Evidence de...

An emerging body of literature has examined cortical activity during walking and balance tasks in older adult and Parkinson’s disease (PD) participants, specifically using functional near infrared spectroscopy (fNIRS) or electroencephalography (EEG) devices. This review aimed to provide an overview of this developing area, in order to inform diseas...

Introduction Whiplash associated disorder (WAD) is a common musculoskeletal condition that often occurs following a road traffic collision (RTC). Physiotherapy is often prescribed to help with symptoms and injuries. Research evidence has demonstrated that acupuncture may be beneficial, but to date no studies have examined the routine clinical use o...

Gait is emerging as a potential diagnostic tool for cognitive decline. The ‘Deep and Frequent Phenotyping for Experimental Medicine in Dementia Study’ (D&FP) is a multicentre feasibility study embedded in the United Kingdom Dementia Platform designed to determine participant acceptability and feasibility of extensive and repeated phenotyping to det...

Gait is emerging as a potential diagnostic tool for cognitive decline. The ‘Deep and Frequent Phenotyping for Experimental Medicine in Dementia Study’ (D&FP) is a multicenter feasibility study embedded in the United Kingdom Dementia Platform designed to determine participant acceptability and feasibility of extensive and repeated phenotyping to det...

Introduction: Musculoskeletal disorders (MSDs) are common following a road traffic collision (RTC) in England. Establishing the anatomical distribution of MSDs following RTC that present to physiotherapists may improve understanding and clinical practice. This study examined anatomical distribution of MSDs that present to physiotherapists within a...

Purpose Musculoskeletal disorders (MSDs) are common following a road traffic collision (RTC) and result in significant costs at both a personal and societal level. Physiotherapy is often prescribed to assess and manage MSDs, with current guidelines and practice primarily focused on neck/upper back pain following a RTC. However several recent studie...

Purpose Musculoskeletal disorders (MSDs) are common following a road traffic collision (RTC) and result in significant costs at both a personal and societal level. Physiotherapy is often prescribed to assess and manage MSDs, with current guidelines and practice primarily focused on neck/upper back pain following a RTC. However several recent studie...

The natural history of falls in early Parkinson’s disease (PD) is poorly understood despite the profound effect of falls on outcome. The primary aim of this study was to describe the natural history of falls, and characterise fallers over 54 months in 99 newly diagnosed people with PD. Seventy-nine (79.7%) participants fell over 54 months and 20 (2...

Distinguishing dementia subtypes can be difficult due to similarities in clinical presentation. There is increasing interest in discrete gait characteristics as markers to aid diagnostic algorithms in dementia. This structured review explores the differences in quantitative gait characteristics between dementia and healthy controls, and between fou...

Abnormal sleep may associate with cognitive decline in Parkinson's disease (PD). Furthermore, sleep dysfunction may associate with worse motor outcome. We hypothesised that PD patients with poor quality sleep would have greater progression in gait dysfunction, due to structural and functional overlap in networks subserving sleep and gait regulation...

Background and aim: Gait impairment is one of the major symptoms in Parkinson’s disease (PD) and is associated with increased incidence of falls, loss of independence and reduced quality of life. Despite advances in medication, gait impairment still remains problematic in PD and thus additional therapeutic strategies are required. Previously, audit...

Objective This study investigated 1) pro-saccades in a newly diagnosed cohort of Parkinson’s disease (PD) compared to healthy older adult controls at baseline, and 2) whether baseline pro-saccades can predict attentional decline over 18months better than traditional computerised testing in PD and controls. Background Cognitive impairments, such as...

Background: Identifying causes of falls for people with Parkinson’s disease has met with limited success. Prospective falls measurement using the “gold standard” approach is challenging. This paper examines the process and outcomes associated with longitudinal falls reporting in this population. Methods: Participants were recruited from ICICLE-GAIT...

Background and aims: Distinguishing dementia subtypes is difficult due to similarities in clinical presentation. Safe and effective gait requires complex cognitive processes, highlighted when observing gait deficits in people with cognitive impairment. There is increasing interest in the role of discrete gait characteristics as markers to aid diagn...

Background: Dementia is significant in Parkinson's disease (PD) with personal and socioeconomic impact. Early identification of risk is of upmost importance to optimize management. Gait precedes and predicts cognitive decline and dementia in older adults. We aimed to evaluate gait characteristics as predictors of cognitive decline in newly diagnos...

Objective: This prospective observational study investigates the role of CSF biomarkers in predicting progression of dopa-resistant gait impairments in Parkinson disease (PD) in the first 36 months from diagnosis. Methods: Quantitative gait analysis was carried out longitudinally using an instrumented walkway (GAITRite) in 108 people with PD and...

Introduction: Gait is a marker of global health, cognition and falls risk. Gait is complex, comprised of multiple characteristics sensitive to survival, age and pathology. Due to covariance amongst characteristics, conceptual gait models have been established to reduce redundancy and aid interpretation. Previous models have been derived from labora...

Free-living ambulation with accelerometer-based devices is an attractive methodology to assess habitual behaviour within Parkinson’s disease (PD). However, slowness of movement can contribute to difficulty in quantifying ambulatory/walking outcomes within this group by these devices. This study investigates the use of a commercial accelerometer dev...

Technological developments have seen the miniaturization of sensors, small enough to be embedded in wearable devices facilitating unobtrusive and longitudinal monitoring in free-living environments. Concurrently, the advances in algorithms have been ad-hoc and fragmented. To advance the mainstream use of wearable technology and improved functionali...

Gait is an important clinical assessment tool since changes in gait may reflect changes in general health. Measurement of gait is a complex process which has been restricted to bespoke clinical facilities until relatively recently. The use of inexpensive wearable technologies is an attractive alternative and offers the potential to assess gait in a...

Gait is emerging as a powerful tool to detect early disease and monitor progression across a number of pathologies. Typically quantitative gait assessment has been limited to specialised laboratory facilities. However, measuring gait in home and community settings may provide a more accurate reflection of gait performance because: (1) it will not b...

Recent research highlights the association of gait and cognition in older adults but a stronger understanding is needed to discern coincident pathophysiology, patterns of change, examine underlying mechanisms and aid diagnosis. This structured review mapped associations and predictors of gait and cognition in older adults with and without cognitive...

Relevance: Innovative research for diagnosis of pathology using physiotherapy Purpose: It has been recognised that cognitive impairment is frequent in people with Parkinson’s disease (PwPD), even at diagnosis(1). It is important to identify those at risk of cognitive decline and Parkinson’s disease dementia (PDD) as both cognitive impairment(1) and...

Background: Gait is an independent predictor of cognitive decline in older adults and may also be an important predictor in Parkinson’s disease (PD). Cognitive domains such as attention are commonly impaired in PD and have been associated with selective features of gait (specifically speed and step length) using cross-sectional analysis. However, l...

Objective: To examine whether gait impairment measured within 4 months of being diagnosed with Parkinson’s disease (PD) can predict decline in attention over the subsequent 3 years. Background: Impaired cognitive function is associated with gait impairment in incident PD in cross sectional studies1. Our preliminary work suggests walking speed can p...

National Institute for Health Research (NIHR) Newcastle BRC/BRU Postgraduate Research Showcase

Background Impaired cognitive function is associated with gait impairment in Parkinson’s disease (PD) (1). Preliminary work shows that gait velocity under single task (ST) conditions predicts change in attention over 18 months; providing emerging evidence for the role of gait as a sensitive marker of disease progression (2). Evidence suggests that...