Thinking and balance practice during rehabilitation

Intervention: Group 1: After the baseline assessment study-participants will receive 30 minutes one-on-one StepIt training sessions, daily, for two weeks (30 min/ day for 10 days = 5 hours of training). For the StepIt training an anti-slippery 90 x 90 cm yoga mat with nine equal number fields (30 x 30 cm) will be used. The supervising therapist will explain and demonstrate stepping sequences (e.g. 3-5-6) on a white board and on the mat. The task is for the participant to memorize and then execute the demonstrated sequence in the tempo that is given by a metronome. When the participant performs the sequence correctly, the sequence will be advanced to the next level. The difficulty level will be increased in following ways: Within the session: 1. At first participants will step with one leg at a time (the other leg remains on the start field) only, later on they will step with both legs. 2. Speed will be advanced from low (55bpm), to moderate (65bpm) to a fast pace (75bpm). These speeds are predefined. From session to session: 1. Training session 1-3: single task (steps only) 2. Training session 4-7: dual-task (steps + motor task (e.g. balance an object in the hands) 3. Training session 8-10: multi-tasking (steps + motor task + cognitive task (e.g. word fluency task) Additionally, the number of steps per sequence will be increased every two training sessions. An experienced physio- or sports therapist, who was instructed in the implementation of the StepIt training, will supervise each training. Furthermore, a study aid will be present in each session to do the documentation and eventually assist the therapist. The study aid was also introduced to the StepIt training. After the end of the training phase the post assessment will take place. All other rehabilitation treatments remain Primary outcome: 1. Acceptance, adherence and safety of this training in the inpatient rehabilitation setting 1a. Inclusion-rate: % of participants in relation to eligible patients 1b. Adherence-rate: % of completed trainings in relation to scheduled trainings 1c. Completion-rate: % of participants who completed = 80% of training in relation to all participants 1d. Adverse events: Falls/ almost falls in the direct and indirect context of the StepIt training), terminations of training due to cognitive and/ or motor exhaustion or training-induced pain or unwell-being 2. Usability and user experience by pwPD 2a. Usability of the training: Evaluated by participants applying an adapted form of the Subject Usability Scale (aSUS) 2b. Evaluation of the relevance of the StepIt training (Likert-Scales) to achieve personal rehabilitation goals (defined at the beginning of the rehabilitation with the Goal Attainment Scale, GAS) 2c. Subjectively perceived joy in the overall training: Physical Activity Enjoyment Scale (PACES) 2d. Subjectively perceived joy in each training session: Visual Analogue Scala (VAS) 2e. Subjectively perceived positive training-effects: self-developed questionnaire 2f. Intention to continue training after the end of the study: self-developed questionnaire 2g. Subjectively perceived cognitive and motor load/ demand during training: NASA Task Load Index (NASA-TXL) 3. Exercise performance 3a. Improvement: Baseline level compared to the highest level achieved 3b. Training load: Number of learned stepping sequences (per session and in overall training) 3c. Speed-error-rate: Errors resulting from speed (yes/ no) 3d. Accuracy-error-rate: Errors caused by stepping outside the correct field Secondary outcome: Cognition: global cognition (Montreal Cognitive Assessment), attention (Test of Attentional Performance (TAP), subtest alertness), executive functions (inhibition: TAP Go/NoGo subtest, flexibility: TAP flexibility subtest, verbal and non-verbal working memory: digit and spatial span of the revised version of the Wechsler Memory Scale (WMS-R)); motor function: mobility (Mini-BEST, Timed Up and Go Test without and with dual task, 10m walk test), functional independance (Functional independance Measure, FIM), motor deficit (Unified Parkinson's disease Rating Scale (MDS-UPDRS), motor part III); sociodemographic and clinical data: age, gender, education level, bodyweight, height, profession, marital status, living situation, time since diagnosis, deep brain stimulation (DBS), (time since DBS surgery), degree of illness, mood, quality of life, physical activity level, fatigue, freezing, subjective fear of falling