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Laboratory of Joan A. O’Keefe, PhD

My expertise is in the detection of gait and balance impairments in a variety of movement disorders. I am a physical therapist with doctoral and postdoctoral training in basic neurobiology and am presently conducting clinical research investigating balance and gait in several neurodegenerative disorders.

I received my BS in physical therapy from the University of Illinois-Chicago and my PhD in anatomy and neurobiology from Loyola University Chicago. I am predominantly studying Fragile X tremor and ataxia syndrome (FXTAS), which occurs in some premutation (PM) carriers of the Fragile X (FMR1) gene.

The short-term goals of my research program are to develop an early detection model for FXTAS and identify additional molecular risk factors for developing this disorder. Together with my collaborators in movement disorders and neurology and my graduate students, I am working toward the following goals:

  • Identify quantitative markers of balance and gait impairments in PM carriers with and without FXTAS.
  • Determine the impact of executive function and cognitive interference on balance and gait function in PM carriers with and without FXTAS.
  • Determine the relationship between age, sex, executive function and FMR1 molecular variables and the presence and severity of balance and gait impairment in PM carriers with and without FXTAS.

Results of this research will help clarify neurological mechanisms underlying balance and gait deficits in FXTAS. It will also establish reliable and quantitative outcomes measures of motor impairment and provide data for future clinical trials. This research is also the first step in characterizing the longitudinal history of motor dysfunction in FXTAS from its earliest stages, thus, paving the way for establishing disease monitoring and modifying strategies in premutation carriers.

My research is relevant to the National Institute of Health’s research plan on FXS and associated disorders, which includes the following goals:

  • Validating quantitative instruments to detect early clinical signs of FXTAS and its progression
  • Identifying of molecular and clinical risk factors in individuals associated with penetrance of FXTAS
  • Defining genotype and clinical phenotype relationships in FXTAS

My second research focus, in collaboration with Dr. Elizabeth Berry-Kravis, revolves around a clinical trial related to the neurodegenerative disorder Niemann-Pick C (NPC). We are using our state-of-the-art quantitative balance and gait measures to determine the efficacy of the drug Hydroxypropyl Beta Cyclodextrin, or HPßCD, in the treatment of motor problems in children and young adults with this disorder.

We are also developing a normative database of gait and balance outcome variables using inertial sensor-based technologies that we anticipate will be very useful in the conduct of future clinical treatment trials in children and young adults with neurodegenerative disorders.



Joan Ann (Joanne) O’Keefe, PhD, PT has extensive clinical and research expertise in evaluating gait, balance, and other motor functions in patients with movement disorders. She received her B.S. in Physical Therapy from the University of Illinois-Chicago, her PhD in Anatomy and Neurobiology from Loyola University Chicago and completed her postdoctoral training at the University of Kentucky. She is presently an Associate Professor of Anatomy & Cell Biology with joint appointments in Neurological Sciences and Occupational Therapy. Her research expertise is in the detection, characterization, and examination of underlying neural mechanisms of gait and balance impairments and associated cognitive interactions in neurodegenerative movement disorders including Fragile X-associated tremor/ataxia syndrome (FXTAS), Parkinson’s disease, and Huntington’s disease.


Technology and Methods

  • Inertial Sensor Based Gait, Balance, and Tremor Analyses
  • Functional near infrared spectroscopy (fNIRS): Portable optical neuroimaging system to examine cortical activation under ecologically valid gait, balance, and cognitive function tasks.
  • MRI image analysis
  • Transcranial Magnetic stimulation (TMS)
  • Dual task treadmill training
  • Neurodevelopmental testing
  • Neuropsychological testing



  • DOD: HT9425-24-1-0099 (PI) “Neural Underpinnings of the Relationship Between Cognitive and Gait Dysfunction in Fragile X-Associated Tremor/Ataxia Syndrome (FXTAS)”. The major goals of this project are to understand the structural and functional neural underpinnings of the relationship between cognitive and gait dysfunction in FXTAS to be applied to future interventional studies.
  • Rush Imaging Research Core Pilot Seed Grant (PI). “Structural and functional brain imaging to identify the neural underpinnings of the relationship between cognitive and gait dysfunction in Fragile X-associated tremor/ataxia syndrome (FXTAS).” The major goal of this seed grant is to collect pilot fNIRS, MRI, and digital gait data in 10 controls and 10 FXTAS individuals to provide preliminary data for a future DOD or R01 grant.
  • Huntington’s Disease Society of America (PI); “Neural underpinnings of cognitive, balance and gait deficits in Huntington’s disease.”  The major goal of this project is to examine cortical activity via portable fNIRS technology to examine cortical functional relationships mediating gait, balance, and cognitive impairments in Huntington’s disease.
  • U01NS113851 (Co-Investigator)
    “Study in Parkinson Disease of Exercise Phase 3 Clinical Trial: SPARX3”.  This is a Phase 3 multi-site RCT to study the impact of moderate or high intensity treadmill exercise on changes in MDS-UPDRS motor scores and digital gait outcome measures longitudinally in persons with early-stage Parkinson disease.
  • Regeneron Pharmaceuticals (Co-PI)
    “Digital Assessment of Gait and Speech in Parkinson’s Disease”. Major goals are to assess the ability of a wearable insole to accurately measure gait in Parkinson disease (PD) and detect clinically meaningful changes in gait in PD.
  • NIH/NICHD K01HD088762 (PI)
    “Impact of Cognition on Balance and Gait Markers for FXTAS”. The major goal of this project is to provide an early detection model for Fragile X tremor/ataxia syndrome (FXTAS) using balance and gait markers and interacting cognitive and molecular factors.
  • Rush Schweppe Translational Science Consortium Pilot grant (PI): “Balance and Gait Biomarkers for Fragile X Tremor/Ataxia Syndrome (FXTAS)”
  • Rush University Cohn Research Fellowship (PI)



Recent select works

O’Keefe JA,  Robertson E., McAsey, A, Swanson, M, Bernard, B, Berry-Kravis E, Hall DA. Cognitive function impacts gait, functional mobility and falls in Fragile X-Associated Tremor/Ataxia Syndrome; under revision review; Gait and Posture; 2018; DOI: 1016/j.gaitpost.2018.09.005

Berry-Kravis, E, Chin, J Hoffmann, A, Winston A, Stoner R, Lagorio L, Friedmann K, O’Keefe, JA. Long-Term Treatment of Niemann-Pick Type C1 Disease with Hydroxypropyl-Beta-Cyclodextrin; Pediatric Neurology. 2018 Mar;80:24-34. PMID: 29429782

Pal G, O'Keefe JA, Robertson E, Bernard B, Anderson S, Hall DA.  Global cognitive function and processing speed are associated with gait and balance dysfunction in Parkinson's disease; J NeuroEng and Rehab. 2016. 13(1): 94-102.

Robertson E, Hall DA, McAsey AR, O’Keefe JA.  Fragile X-associated Tremor/Ataxia Syndrome: Phenotypic comparisons with other Movement Disorders, Clin Neuropsychol. 2016; 30(6):849-900.

Hall DA,  Robertson E, Shelton AL, Losh MC, Mila M, Moreno EG, Gomez-Anson B, Martínez-Cerdeño V,  Grigsby J, Lozano R, Hagerman R, Santa Maria L, Berry-Kravis E, O’Keefe JA. 2016.  Update on the Clinical, Radiographic, and Neurobehavioral Manifestations in FXTAS and FMR1 Premutation Carriers, Cerebellum; 2016;15:578-586.

O’Keefe JA, Robertson E, Hall DA and Berry-Kravis E.  Gait and Functional Mobility Deficits in Fragile X-Associated Tremor/Ataxia Syndrome; Cerebellum; 2016;15(4):475-82.

Hall, DA, Robertson-Dick, E, O’Keefe JA, Hadd AG, Zhou L, Berry-Kravis E.  Repeat Size and X-inactivation in the Clinical Phenotype of Fragile X Premutation Carrier Sisters; Neurol Genet. 2016; 2(1):e45. PMID: 27066582

Pal G, Robertson E, O’Keefe JA, Hall DA. The Cognitive and Motor Profile of GBA-associated Parkinson Disease:  A Review; Movement Disorders: Clinical Practice, 2015; 3: 4–8.

O’Keefe JA, Robertson E, Dunn E, Li Y, Deng Y, Fiutko A, Berry-Kravis E, Hall DA. Characterization and Early Detection of Balance Deficits in Fragile X Premutation Carriers With and Without Fragile X Associated Tremor/Ataxia Syndrome (FXTAS).  Cerebellum, 2015; 14(6):650-62.

Hall DA, Birch R, Anheim M,  Jonch A, Pintado E,  O’Keefe, JA, Troller J,  Hagermann RJ, Fahn S, Berry-Kravis, E, Leehey MA. Emerging topics in FXTAS.  J. Neurodev Dis. 2014; 6: 31-41.

O’Keefe JA, Espinosa-Orias A , Khan H,  Hall DA, Berry-Kravis E,Wimmer MA,. Implementation of a Novel Markerless Motion Analyses System to Quantify Hyperactivity in males with Fragile X Syndrome,  Gait and Posture, 2014; 39 (2):827-30.

Hall DA, O'Keefe JA. Clinical Neurogenetics: Fragile X-associated tremor/ataxia syndrome. Neurol Clin. 2013; 31(4):1073-84.

Hall DA, O’Keefe JA. Fragile X-Associated Tremor Ataxia Syndrome:  The Expanding Clinical Picture, Pathophysiology, Epidemiology, and Update of Treatment. Tremor Hyperkin Mov;2. Epub 2012; pii: tre-02-56-352-1.  PMID: 23439567

Additional publications

Complete List of Published Work in MyBibliography.


Our Current Team

Emily C. Timm, BS (PhD student)
Annam Zaidi, MD (MS student in Clinical Research)
Emily R. Sullivan, BS (Medical Student)
Jack Paras, BS (Research Associate)


Former Graduate Student

Nicollette Purcell

I am a graduate student in the Department of Cell & Molecular Medicine, working with Joan O’Keefe on my master’s thesis. My research is focused on patients with Huntington’s disease (HD), a movement disorder that impairs functional abilities, including gait and cognition. I will be measuring gait variables and cognitive function domains under single and dual-task conditions in individuals who are in the early stages of disease progression. Subjects will then be compared to age-matched controls to determine how HD quantitatively affects gait and cognitive function performance.

I received a BS in human biology from Michigan State University in 2013, and a BMS in pre-medical studies from Dominican University in 2014. Since then, I have been working as a certified nursing assistant caring for patients with HD and amyotrophic lateral sclerosis, and this experience has inspired me to pursue my graduate degree at Rush. It is my privilege to have the opportunity to work with Dr. O’Keefe, in collaboration with Dr. Jennifer Goldman, MD, at one of the nation’s best movement disorder centers.



Joan A. O’Keefe, PhD, PT
Associate Professor
Rush University
Department of Anatomy & Cell Biology
Suite 505B Armour Academic Center
600 South Paulina St.
Chicago, IL 60612
Phone: (312) 563-3940