Department of Physical Therapy Student Theses, Dissertations and Capstones

Document Type


Degree Name

Doctor of Philosophy (PhD) in Physical Therapy

Copyright Statement

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College of Health Care Sciences - Physical Therapy Department

First Advisor

Jennifer Canbek

Second Advisor

George Fulk

Third Advisor

Lee Dibble

Publication Date / Copyright Date



Nova Southeastern University


Problem Statement: Individuals with Parkinson Disease (PD) often experience difficulty transferring from sit to stand (STS). Current evidence suggests cues which promote an external attentional focus improve gait and transfers for individuals with PD. However, this research utilizes cues which are difficult to replicate in clinical or natural environments making the findings difficult to generalize or implement. Purpose: The primary purpose of this study is to determine the effect of 3 different explicit cues on STS for individuals with PD. Additionally we sought to determine if, in this population, a relationship exists between latency of movement initiation and postural sway in early standing, changes in joint angle between conditions and postural sway in early standing, and cue provided during the transfer and postural sway in early standing. Procedures/Methodology: Thirteen individuals in both the experimental and control groups participated in this cross-over design study. Both groups completed trials of self-initiated uncued STS transfers. Those in the experimental group also completed trials of STS transfers in 3 conditions: with an external attentional focus of reaching to targets, with an external attentional focus of concurrent modeling, and with an explicit cue for an internal attentional focus. Data was collected by trained testers and utilized valid and reliable body worn inertial measurement unit sensors. ANOVAs were used to compare performance between conditions and to the performance of the healthy control group. Bonferroni corrections were completed to reduce the likelihood of accepting a false positive. Results: Both cues that elicit an external attentional focus improved motor control during the sit to stand transfer. However, only modeling was able to improve both motor control and postural control. Cueing that promoted an internal attentional focus resulted in decreased motor control and postural control. Additionally, a moderate positive correlation was found between standing taller than typical and postural sway. Clinical Implications: Our results provide evidence for clinicians to better tailor treatment methodologies to the needs of individuals with PD. Optimal cueing can be utilized as compensations that reduce caregiver burden and increase independence of individuals with PD.


Physical Therapy


Cues, Movement, Parkinson disease, Postural balance