Gait & Posture 55 (2017) 62–67

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Gait & Posture

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Full length article

Falls in people with Parkinson’s disease: A prospective comparison of MARK

community and home-based falls
⁎
Robyn M. Lamonta, , Meg E. Morrisb,c, Hylton B. Menzb, Jennifer L. McGinleyd, Sandra G. Brauera
a
School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, 4072, Australia
b
School of Allied Health, La Trobe University, Melbourne, 3086, Australia
c
Northpark Private Hospital Healthscope, Melbourne, Australia
d
Melbourne School of Health Sciences, The University of Melbourne, 3010, Melbourne, Australia

A R T I C L E I N F O A B S T R A C T

Keywords: Background: Falls are common and debilitating in people with Parkinson’s disease (PD) and restrict participation
Parkinson’s disease in daily activities. Understanding circumstances of falls in the community and at home may assist clinicians to
Fall target therapy more effectively.
Community Objective: To compare the characteristics of community and home fallers and the circumstances that contribute
to falls in people living with PD.
Methods: People with mild-moderately severe PD (n = 196) used a daily falls diary and telephone hotline to
report prospectively the occurrence, location and circumstances of falls over 14 months.
Results: 62% of people with PD fell, with most falling at least once in the community. Compared to people who
fell at home, the community-only fallers had shorter durations of PD (p = 0.012), less severe disease
(p = 0.008) and reported fewer falls in the year prior to the study (p = 0.003). Most falls occurred while
people were ambulant, during postural transitions and when medication was working well. Community-based
falls were frequently attributed to environmental factors such as challenging terrains (p < 0.001), high
attention demands (p = 0.029), busy or cluttered areas (p < 0.001) and tasks requiring speed (p = 0.020).
Physical loads were more often present in home than community-based falls (p = 0.027).
Conclusion: Falls that occur in the community typically affect people with earlier PD and less severe disease than
home-based falls. Individuals experiencing community-based falls may benefit from physiotherapy to manage
challenging environments and high attention demands.

1. Introduction between intrinsic factors such as balance impairments and extrinsic

Falls are common and challenging for people with Parkinson’s
disease (PD) with many experiencing frequent falls [1]. Falls can have
devastating consequences including restriction or avoidance of physical
activities [2,3] and reduced health-related quality of life [4]. Identify-
ing individuals who are at risk of falling, and preventing or minimising
falls is a priority in comprehensive patient care. A “fall type approach”
to rehabilitation has been advocated for managing falls in people with
PD [5], whereby falls circumstances directly inform tailored interven-
tion. A targeted approach to fall prevention would be assisted by
understanding fall types and their predisposing risk factors.
Historically it was thought that falls in people with PD were
primarily caused by intrinsic factors [2,6]. Fall events are however
now recognised as multifactorial and the result of an interaction
factors including environmental demands and hazards [7]. Some
intrinsic factors appear to predispose people to falling in particular
contexts [8]. For example, people with PD who fall outdoors have a
propensity for falls triggered by tripping, slipping, loss of balance or
loss of concentration [8]. In contrast, recurrent fallers are more inclined
to fall at home, in falls they attribute to muscles giving way, dizziness or
loss of balance [8].
After experiencing a fall, some people with PD restrict their physical
activities to avoid harm [2,9]. Falls that occur away from home can
result in embarrassment and psychological distress [10]. If people fall
in the community, they may restrict their activities to the close
surrounds of their home, which may reduce independence. It is there-
fore important to identify characteristics of people with PD who fall in
the community and their potential contributing factors.

⁎
Corresponding author.
E-mail addresses: r.lamont@uq.edu.au (R.M. Lamont), M.Morris@latrobe.edu.au (M.E. Morris), H.Menz@latrobe.edu.au (H.B. Menz), mcginley@unimelb.edu.au (J.L. McGinley),
s.brauer@uq.edu.au (S.G. Brauer).

http://dx.doi.org/10.1016/j.gaitpost.2017.04.005
Received 7 November 2016; Received in revised form 27 February 2017; Accepted 2 April 2017
0966-6362/ © 2017 Elsevier B.V. All rights reserved.
R.M. Lamont et al. Gait & Posture 55 (2017) 62–67

Table 1
Factors that may have contributed to falls.

Factor Description

Ambulant At the time of the fall they were walking, including initiating or terminating walking.
Indoor The fall occurred inside a building.
Freezing At the time of the fall they reported experiencing freezing of gait.
Intrinsic only The fall was related to intrinsic or personal factors only (e.g. dizziness or hypotension).
Distance At the time of the fall they had been walking a long distance, which may have contributed directly to the fall or to fatigue which may
have been related to the fall.
Temporal At the time of the fall they were walking quickly, felt pressured to rush, or they were crossing a road.
Ambience At the time of the fall the lighting was dull, very bright, that the level of lighting had changed or that the weather was inclement,
causing reduced visibility (rain or fog) or making it difficult to move (wind).
Terrain At the time of the fall they were walking on a ramp, stairs, a curb, a slope, a hill or a rough, slippery, sticky (i.e. high friction) or soft
surface, or that they had walked from one surface to another.
Anticipated external physical load At the time of the fall the individual was carrying something, pushing or pulling a door open or closed.
Unanticipated external physical load They were knocked, pulled or jolted off balance by an external force just prior to the fall.
Attention At the time of the fall they were somehow distracted from the postural task and/or required to share their attention between the
postural task and another activity (e.g. walking while finding their way).
Postural Transition At the time of the fall they were initiating or terminating walking, changing speed or direction, sitting down or standing up, reaching
up or down or changing the position of their head to look left, right, up or down.
Density The participant stated that at the time of the fall they were walking in an environment that was or could be presumed to be busy (e.g.
walking on a train, in a grocery store or to their seat in a theatre).
Unable to determine environmental cause No specific environmental factors were present at the time of the fall, however was not sufficient to rule out the presence of
environmental factors (e.g. feet froze and I fell).
Inevitable fall It is likely that under the same circumstances a healthy, young person would have been unable to recover from the perturbation and
would have fallen.

The first aim of this study was to compare the characteristics of
people with PD who fell only in their community, to those who fell only
at home, as well as those who fell at both locations. It was hypothesised
that people who fall only in the community would have shorter disease
duration and less severe symptoms than people who fell at home only,
or in both locations. Second, we examined the personal and environ-
mental factors that contributed to falls in each location, and predicted
that these would differ.
2. Methods
We conducted a secondary analysis of prospective falls data
collected as part of a large randomised controlled trial (RCT) assessing
a fall prevention intervention in the PD population [11]. The protocol
for the RCT data collection has been published previously [11,12]. The
study was approved by the Southern Health (Approval # 060035) and
The University of Melbourne Health Sciences (Approval # 0828579)
Human Research Ethics Committees.
2.1. Participants
A total of 210 people with idiopathic PD were recruited through
movement disorders clinics, private neurologists, physiotherapists and
local newspaper advertising in Victoria, Australia. Participants were
required to have a confirmed diagnosis of idiopathic Parkinson’s
disease, be willing and able to provide written informed consent and
be able to walk independently with/without gait aids. People who had
deep brain stimulation, scored less than 24 on the Mini Mental State
Examination (MMSE) [13] and those on major tranquilisers were
excluded.
2.2. Procedure
Participants attended an assessment session at which a question-
naire was used to collect demographic data including age and disease
duration. Severity of PD symptoms was rated using the Unified
Parkinson Disease Rating scale (UPDRS) [14] and the modified Hoehn
and Yahr scale (mHY) [15]. The MMSE provided information about the
participants’ cognitive status.
During the intervention (8 weeks) and 12-month follow-up periods
participants were asked to phone a free fall hotline as soon as possible
after a fall. A fall was defined as “an unexpected event in which the
participant comes to rest on the ground, floor or lower level” [16]. The
hotline operator recorded details about the fall, including the time and
location of the fall, a description of what caused the fall, the effective-
ness of medication, whether freezing had occurred at the time of the fall
and whether an injury occurred. Falls were also recorded on a calendar
that was returned to researchers monthly. Falls reported on the
calendar, but not on the falls hotline were followed up by telephone
and where possible, details of the fall were added.
2.3. Data analysis
A community-based fall was a fall that occurred anywhere other
than the participants’ own home or garden. Falls that occurred at the
participant’s own home, including their garden or garage were classi-
fied as home-based falls. Participants were categorised as those who
reported only community-based falls, only home-based falls or both
home and community-based falls. Individuals who reported more than
one fall in the 14-month trial period were classified as frequent, very-
frequent fallers or extremely-frequent fallers based on the number of
falls reported [17,18].
The falls description was analysed to identify factors or circum-
stances that may have contributed to the fall. Each fall was reviewed to
determine whether it occurred while ambulant, while indoors or
outdoors, while freezing of gait (FOG) was occurring and based on
the environmental challenges that may have contributed to the fall.
Descriptions of falls that indicated the fall occurred due to an intrinsic
event alone, were classified as “intrinsic only”. Falls were classified as
“inevitable” if it was considered that the fall would have occurred in a
young, healthy person. Environmental challenges were classified using
the environmental dimensions framework [19] which has previously
been used to describe the contribution of specific environmental
challenges to mobility disability in older adults [20].
This framework describes eight environmental challenges that are
detailed in Table 1. It has not previously been applied to the analysis of
falls, and was used here with one modification. The “external physical
load” domain was separated into anticipated and unanticipated physi-
cal loads based on whether anticipatory or reactive postural adjust-
ments would have been required to prevent a fall.
Content analysis was initially performed independently by two of
the investigators (RL and SB) who then met to identify and discuss

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R.M. Lamont et al. Gait & Posture 55 (2017) 62–67

discrepancies in their analyses. Consensus was reached by discussion.
Multiple factors could contribute to each fall. In the example below,
the fall was attributed to density, anticipated physical load, attention
demands, postural transition and terrain characteristics.
“She was at a friend’s birthday party and there were a lot of people
around. She had picked up a heavy bowl in the kitchen and was saying
goodbye to people. She had turned around and had not seen the step
and missed the step and fell forward.”
Statistical analyses were performed using IBM SPSS Version 18.0
(IBM Corp). Continuous data were assessed for normality using the
Kolmogorov-Smirnov statistic and confirmed visually with histograms
and normality plots. The characteristics of the sample were described
using means and standard deviations for continuous, parametric data,
medians and ranges for continuous non-parametric data and frequen-
cies and proportions for categorical variables. Between group differ-
ences were tested using one-way ANOVA’s for parametric data, Kruskal-
Wallis tests for non-parametric data and Chi-squared test for categorical
data. Post-hoc comparisons were made using the Tukey HSD test and
Mann-Whitney U test. The significance level was set at α = 0.05.
To avoid over reporting repeated falls circumstances that may have
occurred in very-frequent fallers (> 60 falls), falls circumstances were
also analysed with very-frequent fallers excluded.
3. Results
The characteristics of the 196 participants are presented in Table 2.
In total, 62% of participants fell 1835 times during the 14-month
recording period (Table 3). Location was reported for 48% of falls, with
146 community and 728 home-based falls identified (Table 3).
Almost three quarters (n = 90; 74%) of fallers reported recurrent
falls (Fig. 1). Seven participants fell extremely frequently (> 60 falls)
and accounted for 1046 (57%) of the falls that were reported. These
extremely-frequent fallers accounted for almost 75% of falls for which
location was unknown and less than one-third of these falls could be
classified based on location. (Fig. 1). Approximately one-third of falls
for which location was known resulted in injury (277, 31.7%). There
was no difference in the frequency of injuries between community and
home-based falls (p = 0.576).
3.1. Characteristics of fallers
The majority (55%) of fallers experienced community-based falls,
with 18 reporting only community falls and 49 who fell in both
locations. Forty-nine people only fell at home. Six fallers (5%) did not
record a fall location and therefore could not be allocated to a group.
The community-only fallers experienced the fewest falls, followed
by the home-only then the home and community fallers (Table 2). The
community-only fallers reported a similar number of community-based
falls as the home and community fallers. The home and community
fallers reported a higher number of home-based falls than the home-
only fallers. Fewer community-only fallers fell recurrently compared to
the home-only fallers (p = 0.001) and home and community fallers
(p < 0.001).
The groups did not differ in age, gender distribution or MMSE score
(Table 2). Group differences were found for disease duration, modified
HY stage, UPDRS-ADL and motor subsection scores and falls history.
The community-only fallers had lower UPDRS-ADL and UPDRS-motor
subsection scores than the home-only fallers (p = 0.015 and p = 0.034

Table 2
Participant characteristics.

All Participants Home-only Community- only Home & Community p-value Group Single Recurrent p-value
(n = 196) Fallers Fallers (n = 18) Fallers (n = 49) differences Fallers Fallers
(n = 49) (p < 0.05) (n = 32) (n = 89)

BASELINE CHARACTERISTICS
Age (years)* 67.4 (9.5) 68.1 (10.2) 65.1 (11.6) 68.2 (9.1) 0.481 68.1 (11.1) 67.8 (9.6) 0.887
Male gender† 129 (66) 24 (49) 13 (72) 32 (65) 0.126 18 (56) 55 (61) 0.630
Disease duration 5.0 (0–30) 5.0 (1–28) 4.0 (1–12) 7.0 (1–30) 0.015 1,3; 2,3 4 (0.5–14) 6 (0.5–30) 0.002
(years)¥
Modified 2.6 (0.8) 2.6 (0.8) 2.2 (0.5) 2.8 (0.8) 0.010 2,3 2.2 (0.6) 2.8 (0.8) 0.002
Hoehn & Yahr
Stage*
Stage 1.0† 21 (10.7) 2 (4.1) 1 (5.6) 3 (6.1) 3 (9.4) 4 (4.4)
Stage 1.5† 12 (6.1) 4 (8.2) 1 (6.0) 1 (2.0) 2 (6.3) 4 (4.4)
†
Stage 2.0 53 (27.0) 11 (22.4) 8 (47.1) 7 (14.0) 14 (43.8) 15 (16.7)
Stage 2.5† 33 (16.8) 11 (22.4) 6 (35.3) 6 (12.0) 8 (25.0) 15 (16.7)
Stage 3.0† 55 (28.1) 13 (26.5) 2 (11.8) 22 (44.0) 5 (15.6) 34 (37.8)
Stage 4.0† 21 (10.7) 8 (16.3) 0 10 (20.0) 0 18 (20.0)
UPDRS − ADL 11.4 (6.0) 13.4 (5.4) 8.9 (3.1) 14.0 (6.6) 0.005 1,2; 2,3 9.2 (4.0) 13.9 (6.1) < 0.001
*
(score)
UPDRS − Motor 15.0 (5.9) 16.6 (5.8) 12.6 (3.5) 17.1 (6.0) 0.016 1,2; 2,3 14.1 (3.8) 16.9 (6.1) 0.004
(score)*
MMSE (score)¥ 29 (7) 29 (24–30) 29 (26–30) 29 (24–30) 0.508 29 (25–30) 29 (24–30) 0.348
Falls history (yes)† 107 (54.6) 31 (63.3) 9 (50) 41 (83.7) 16 (50.0) 68 (75.6) 0.007
12-month falls history 1 (0–300) 1 (0–300) 1 (0–6) 4 (0–100) 0.003 1,3; 2,3 1 (0–4) 3 (0–300) < 0.001
(number) ¥

REPORTED FALLS
Fall number¥ 1 (0–329) 3 (1–75) 1 (1–3) 7 (2–329) < 0.001 1,2: 1,3; 2,3 1 (1–1) 5 (2–329) < 0.001
Recurrent fallers† 88 (44.9) 35 (71.4) 4 (22.2) 49 (100) < 0.001 1,2: 1,3; 2,3 – –
Community-based 0 (0–15) – 1 (1–3) 1 (1–15) 0.074Ω 0 (0–1) 1 (0–15) 0.012
falls¥
Home −based falls¥ 0.5 (0–102) 2 (1–27) – 4 (1–102) 0.001π 0 (0–1) 3 (0–102) < 0.001

* Mean (SD), p-value from ANOVA and Tukey HSD test.

†
Frequency (%), p-value from Chi-square test.
¥
Median (range), p-value from Kruskal-Wallis and Mann-Whitney U test (α = 0.05). Group 1 = Home-only fallers. Group 2 = Community-only fallers; Group 3 = Home and
Community fallers.
Ω
=Only groups 2 & 3 were compared.
π
Only groups 1 & 3 were compared.

64
R.M. Lamont et al.
Table 3
Frequency of fallers and falls.
All
Number of fallers (% of all participants) 122 (62.2)
Number of falls (% of all falls) 1835 (100)
Mean (SD) number of falls per person 15.0 (43.2)
Median (Range) number of falls per person 3 (1–329)
Fig. 1. Number of fallers grouped by fall frequency (black) and proportion of falls for which location was reported, grouped by fall frequency.
respectively) and the home and community fallers (p = 0.004 and
p = 0.014). Mean mHY stage was also lower in the community-only
fallers compared to the home and community fallers (p = 0.008).
Participants who reported both home and community falls had
significantly longer duration of PD, and reported significantly more
falls in the year prior to the study than the community-only (p = 0.012
and p = 0.003 respectively) and home-only fallers (p = 0.022 and
p = 0.010 respectively).
Compared to recurrent fallers, single fallers had a shorter disease
duration (p = 0.002), less advanced mHY stage (p = 0.002), lower
UPDRS-ADL (p < 0.001) and UPDRS-motor subsection (p = 0.004)
scores and fewer falls in the year prior to their baseline assessment
(p < 0.001).
3.2. Circumstances of falls
The causes of 576 falls (31.4%) were described by participants.
During the independent content analysis, the two reviewers agreed on
4767 potential contributing factors (92%). Consensus was reached by
discussion for the other 8%.
Compared to home-based falls, community-based falls were more
likely to occur while ambulating and when outdoors (p < 0.001)
(Fig. 2A). Community-based falls were also less frequently attributed to
freezing than home-based falls (p = 0.015). In the majority of falls
antiparkinsonian medication was reported to be working well (> 60%)
with no difference between community-based and home-based falls
(Fig. 2B).
Fall descriptions were further analysed to identify the environmen-
tal challenges present at the time of the fall (Fig. 2C). In 44% of the
community and 32% of the home-based falls, multiple environmental
dimensions contributed. Terrain was the environmental dimension that
most often contributed to community-based falls, and significantly
fewer home-based falls (p < 0.001). Attention demands contributed to
approximately one third of falls, more often community than home-
65
Gait & Posture 55 (2017) 62–67
Community-based Home-based Fall location unknown
67 (34.2) 98 (50.0) 58 (29.5)
146 (8.0) 728 (39.6) 961 (52.4)
1.2 (2.1) 6.2 (13.6) 8.0 (34.8)
1 (0–15) 2 (0–102) 0 (0–284)
based falls (p = 0.029). Similarly, density and temporal demands were
present in 10% or less of falls but more often in community than home-
based falls (p < 0.001 and p = 0.020). Postural transitions, such as
moving between sitting and standing, frequently contributed to both
community and home-based falls with no difference between groups
(p = 0.170). Anticipated physical loads, such as opening a door were
more frequently present during home-based compared to community-
based falls (p = 0.027). Unanticipated physical loads and ambience
contributed to a similar proportion of home and community-based falls
(p > 0.117).
The factors related to falls circumstance differed little between
single and recurrent fallers. Recurrent fallers were more likely to report
falls related to freezing of gait (p = 0.006). Single fallers were far more
likely to report that negotiating complex terrain (p = 0.006) contrib-
uted to the fall. When extremely-frequent fallers were excluded from
the analysis there was no difference between the proportion of home
and community-based falls related to freezing of gait (p = 0.368) or
attention demands (p = 0.759).
4. Discussion
This is the first prospective study to compare the characteristics of
and factors associated with community and home-based falls in people
with PD. The 17% community-fall rate is comparable to the annual 12%
rate previously reported [21]. The current study is the first to
demonstrate the high proportion of fallers who experienced commu-
nity-based falls and that the injury rate associated with community-
based falls was similar to home-based falls.
Research in older adults has shown that those who fall outdoors are
more physically active, with less impaired walking and balance than
those who fall only indoors [22]. Older adults with walking and balance
deficits may reduce their outdoor activities to reduce their risk of falling
again [22]. It was therefore hypothesised that people who fell only in
the community would have shorter disease duration and less severe
R.M. Lamont et al.
Fig. 2. Proportion of community (black) and home-based (grey) falls attributed to a) circumstances; b) medication effect; c) environmental challenges. P-value * 0.025–0.05, **
0.001–0.025, *** < 0.001.
symptoms than people who fell at home. The group who fell only in the
community did have the least advanced disease and least severe motor
impairment and disability. Somewhat surprisingly however, the group
with the most advanced disease, most severe motor symptoms, greatest
disability and most frequent falls in the past fell in both locations. This
suggests that either some people with PD do not sufficiently modify
their community-based activity to prevent falling, or individuals may
be at such high risk of falling that community-based falls occur with
low levels of community activity. Future research utilising new
technologies to continuously monitor physical activity is needed to
further explore the interaction between volume of ambulatory activity
and falls.
When fall circumstances were examined, environmental challenges
such as postural transitions, attention demands, anticipated physical
loads and terrain characteristics were frequently associated with falls in
both locations. Previous research has concluded that falls in people
with PD are most commonly due to intrinsic causes [2]. The results of
this study suggest that although an intrinsic factor may be the primary
reason for a person being unable to regain their balance, without the
contribution of an environmental trigger many falls may not have
occurred. Exploring the environmental factors that contribute to falls is
important in understanding the type of fall that occurred and planning
a targeted prevention strategy.
Environmental challenges that were identified to contribute to
community-based falls differed to those of home-based falls. This
reflects in part the different demands on the sensorimotor system in
the home and community environments [19]. It may also suggest that
different symptoms of PD predispose some people to experiencing
home-based falls, and others community-based falls. For example,
difficulty maintaining gait and postural stability with concurrent
attention demands [23,24] and negotiating obstacles [3,25] are known
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Gait & Posture 55 (2017) 62–67
difficulties for people with PD. Recent consensus has suggested that
researchers and clinicians should work to identify fall types and to
better understand the people who experience these different falls [5].
Future falls prevention strategies that directly target risk factors
associated with the specific fall type and location may prove more
effective. Whether interventions aimed at improving gait with con-
current attention demands [26] could effectively reduce falls associated
with attention demands, or a “slow-down and concentrate” approach
[10] is more appropriate remains to be examined.
In this study, FOG was reported to contribute to more home-based
falls than community-based falls. Tasks such as managing doorways and
negotiating small spaces are known triggers of FOG [27,28] and
arguably more likely to occur when walking at home. Episodes of
freezing are also more likely to occur during the “off” phase of the
medication cycle [28], when people with PD may be less likely to spend
time in the community. Not surprisingly, FOG was more frequently
reported to contribute to falls in recurrent fallers than single fallers.
Indeed, when the participants who fell extremely frequently were
removed from this analysis, there was no significant difference in the
proportion of community and home-based falls attributed to freezing.
Further investigation of the characteristics of fallers and the complex
relationship between falls, activity and FOG is warranted.
Most falls in this study occurred while medication was working
well, a finding also reported in previous prospective studies [2]. Recent
studies have demonstrated that high-intensity exercise interventions
can effectively reduce the rate of falls in people with mild and moderate
PD [9,29]. Furthermore, a lower intensity, but task- and context-
specific exercise program, incorporating indoor and outdoor training
and targeting the spectrum of balance systems, has been shown to
reduce the number and severity of injurious falls, and improve balance
confidence in people with PD [30]. The impact of targeted training
R.M. Lamont et al.
specifically addressing factors associated with community- and home-
based falls should be investigated.
The most significant limitation of this study was the reliance on self-
reported data [17]. There were several novel measures taken in this
study to ensure data quality and accuracy was high. There was a high
rate of recurrent falls in this sample, leading to some concern that the
inclusion of all falls may have led to over-representation of circum-
stances repeatedly reported by the same participant. Frequent-fallers in
this study were instructed to report only the number of falls reported as
providing detailed accounts of these falls was considered overly
burdensome. Many falls reported by frequent fallers were therefore
not included in the analysis as fall location was unknown (Fig. 1). There
are indeed other variables that can contribute to falls in this population
that were considered beyond the scope of this analysis. Examples of
these include comorbid conditions, orthostatic hypotension and phar-
maceutical interventions.
5. Conclusion
Many people with PD who fall do so in the community. This may
lead some people to avoid community-based activities to prevent future
falls. Factors associated with home and community-based falls differed.
Falls prevention strategies may prove more effective if targeted to
specific sub-groups of people with PD defined by the type and severity
of the symptoms they experience. These strategies may specifically aim
to prevent falls in the location and circumstances that individual is most
likely to fall. Future research exploring the ability to predict fall
circumstance based on personal and disease-related factors identified
here is an important next step.
Conflict of interest
The authors have no conflict of interest to report.
Funding
This work was supported by the Michael J. Fox Foundation (US)
(Clinical Discovery Grant, 2006). HBM is a National Health and Medical
Research Council Senior Research Fellow (ID: 1020925).
Acknowledgments
We would like to acknowledge and thank the participants for their
support of this study. We also acknowledge the support of all the
research staff who implemented the study.
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