Parkinson Disease
Conditions
Keywords
Magnetic Resonance Imaging, Neurology, Neurosciences, Physical Medicine, Parkinson Disease, Rehabilitation
Brief summary
The purpose of this research study is to learn more about brain activity when individuals with and without Parkinson disease (PD) move their lower limbs. The investigators also want to see if and how two different types of partnered dance affect brain activity in individuals with and without PD. Testing will take place at the Atlanta VA Medical Center and at Emory University. The investigators expect to enroll about 140 people for this study over a five-year period.
Detailed description
Persons with Parkinson's disease (PD) have impaired mobility, which adversely affects their quality of life. The effectiveness of adapted tango dance, in which participants both lead (internally guide: IG) and follow (externally guide: EG) movement has been shown. To improve outcomes in those with PD, the underlying brain mechanisms for both motor impairments and improvement must be studied. IG and EG movements have distinct brain activity patterns. Individuals with PD have trouble with IG movement but this problem is helped by strategies used while leading. During following, participants with PD can use many external cues, which helps movement in PD, because EG tasks bypass the basal ganglia, the part of the brain affected by PD. In older persons with PD, the investigators aim to: * determine brain activation patterns during IG and EG foot movement. * look into effects of IG and EG training on brain activation along with mobility improvements. The investigators will begin with a functional Magnetic Resonance Imaging test in a scanner. The investigators will look at brain area correlates of a clinically-used foot-tapping task, during IG and EG conditions in older persons with and without PD. Then, the investigators will assess the relative effectiveness of IG versus EG training during an adapted tango class, compared to a group that participates in health education, for improved mobility and foot tapping. Participants with PD will be assessed for disease severity. They will receive tests of outcome measures while OFF and ON PD-specific medications at the following time points: * 1 week before training * 1 week after training * 1 month after training Participants must attend 20 lessons of IG or EG adapted tango in 12 weeks, taught by an experienced instructor. In the functional MRI (fMRI) scanner, the investigators will assess participants for improved foot tapping after training. The investigators will also look at changes in activation in specific brain circuits along with training effects upon mobility. The long-term goal is to improve motor training as much as possible for persons with PD by understanding foot movement brain circuitry in PD as well as brain changes in circuitry through which training is effective. This work proposes to illumine information about brain function that is very important to continued progress in rehabilitative care of persons with PD.
Interventions
BEHAVIORALAdapted Tango Dancing
Composed of simple steps, tango involves frequent movement initiation and cessation, multi-directional perturbations and varied rhythms. Participants focus on trunk control and stepping strategies, coordination, somatosensory awareness, attention to partner, path of movement, and aesthetics. Sessions will begin with a typical dance class warm-up consisting of breathing, limbering and postural alignment to upbeat music. Novel step elements will be introduced every class period. Those with PD will partner with an individual without PD. After novel step introduction, the instructor will present rhythmic training, which is indispensable to partnered dancing. Participants will learn 'typical' rhythms from tango and Latin dances, based upon the system of quicks (Q) and slows (S), ubiquitously used in ballroom dance training to understand the temporal relationship of movement to music.
BEHAVIORALBehavioral Control (BC) Condition
Group health education sessions adapted to the needs of individuals with PD, about pharmacological management, nutrition, sleep disorders, cognitive deficits, bereavement coping, mobility, balance and home safety.
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
40 Years to 70 Years
Healthy volunteers
Yes
Inclusion criteria
* Age 40 - 70 years * Willingness to spend 1-h in a scanner * Able to walk with or without an assistive device 10 feet * Best corrected/aided acuity better than 20/70 in the better eye * Absence of dementia or vascular cognitive impairment * Absence of primary memory deficits
Exclusion criteria
* Deep brain stimulator implants, Metallic implants, fragments, or pacemakers * Montreal Cognitive Assessment (MocA) score \< 24 * Pure-tone threshold sensitivity \> 40 dB * Peripheral neuropathy * Untreated Major Depression * History of stroke, or traumatic brain injury
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Percent Signal Change | 12 weeks | Percentage of baseline BOLD signal across activated brain regions. Activation values that remain significant after type-I error control in imaging software are averaged across brain regions, converted to Percent Signal Change, and presented as Mean (%) ± SD (%) across brain regions investigated. |
| Connectivity Strength | 12 weeks | Changes in average connectivity strength across striatal-thalamo-cortical (STC) and cerebello-thalamo-cortical (CTC) circuits, as measured by average cross correlation coefficient between the seed regions of the circuits. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Internally Guided Training (IG) Adapted tango dancing is a sophisticated, yet accessible system of tactile communication that conveys motor intentions and goals between a leader and follower. Those in IG training will choose direction, timing and amplitude of each successive step, and will communicate this information to their partner through moving their frame and center of mass.
Adapted Tango Dancing: Composed of simple steps, tango involves frequent movement initiation and cessation, multi-directional perturbations and varied rhythms. Participants focus on trunk control and stepping strategies, coordination, somatosensory awareness, attention to partner, path of movement, and aesthetics. Sessions will begin with a typical dance class warm-up consisting of breathing, limbering and postural alignment to upbeat music. Novel step elements will be introduced every class period. Those with PD will partner with an individual without PD. After novel step introduction, the instructor will present rhythmic training, which is indispensable to partnered dancing. Participants will learn 'typical' rhythms from tango and Latin dances, based upon the system of quicks (Q) and slows (S), ubiquitously used in ballroom dance training to understand the temporal relationship of movement to music. | 34 |
| Externally Guided Training (EG) Those in EG will learn to attend to sensory cues for movement direction, timing and amplitude of steps, communicated from their partner to them via the frame and center of mass. The 'follower' will wait to receive the movement cue before moving.
Adapted Tango Dancing: Composed of simple steps, tango involves frequent movement initiation and cessation, multi-directional perturbations and varied rhythms. Participants focus on trunk control and stepping strategies, coordination, somatosensory awareness, attention to partner, path of movement, and aesthetics. Sessions will begin with a typical dance class warm-up consisting of breathing, limbering and postural alignment to upbeat music. Novel step elements will be introduced every class period. Those with PD will partner with an individual without PD. After novel step introduction, the instructor will present rhythmic training, which is indispensable to partnered dancing. Participants will learn 'typical' rhythms from tango and Latin dances, based upon the system of quicks (Q) and slows (S), ubiquitously used in ballroom dance training to understand the temporal relationship of movement to music. | 31 |
| Behavioral Control (BC) BC participants will attend group health education sessions adapted to the needs of individuals with PD, about pharmacological management, nutrition, sleep disorders, cognitive deficits, bereavement coping, mobility, balance and home safety. Participants in this training will be instructed not to change their habitual exercise routines. After completing health education, participants will be assigned to an IG or EG training class but will not undergo evaluations.
Behavioral Control (BC) Condition: Group health education sessions adapted to the needs of individuals with PD, about pharmacological management, nutrition, sleep disorders, cognitive deficits, bereavement coping, mobility, balance and home safety. | 22 |
| Total | 87 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| One Month Washout | Lost to Follow-up | 0 | 1 | 1 |
| Training | Lost to Follow-up | 10 | 6 | 3 |
Baseline characteristics
| Characteristic | Internally Guided Training (IG) | Externally Guided Training (EG) | Behavioral Control (BC) | Total |
|---|---|---|---|---|
| Age, Continuous | 70.7 years STANDARD_DEVIATION 7 | 68.6 years STANDARD_DEVIATION 8.5 | 68.0 years STANDARD_DEVIATION 9.5 | 69.36 years STANDARD_DEVIATION 8.29 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 34 Participants | 30 Participants | 22 Participants | 86 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Black or African American | 6 Participants | 6 Participants | 4 Participants | 16 Participants |
| Race (NIH/OMB) More than one race | 2 Participants | 1 Participants | 1 Participants | 4 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Race (NIH/OMB) White | 26 Participants | 22 Participants | 16 Participants | 64 Participants |
| Sex: Female, Male Female | 13 Participants | 14 Participants | 6 Participants | 33 Participants |
| Sex: Female, Male Male | 21 Participants | 17 Participants | 16 Participants | 54 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 34 | 0 / 31 | 0 / 22 |
| other Total, other adverse events | 0 / 34 | 0 / 31 | 0 / 22 |
| serious Total, serious adverse events | 0 / 34 | 0 / 31 | 0 / 22 |
Outcome results
Primary
Connectivity Strength
Changes in average connectivity strength across striatal-thalamo-cortical (STC) and cerebello-thalamo-cortical (CTC) circuits, as measured by average cross correlation coefficient between the seed regions of the circuits.
Time frame: 12 weeks
Population: Sample size reflects study attrition and inability to tolerate fMRI scanning
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Internal Guidance Training (IG) | Connectivity Strength | -0.04 correlation coefficient | Standard Deviation 0.51 |
| Externally Guided Training (EG) | Connectivity Strength | -0.03 correlation coefficient | Standard Deviation 0.43 |
| Behavioral Control (BC) | Connectivity Strength | 0.14 correlation coefficient | Standard Deviation 0.34 |
Primary
Percent Signal Change
Percentage of baseline BOLD signal across activated brain regions. Activation values that remain significant after type-I error control in imaging software are averaged across brain regions, converted to Percent Signal Change, and presented as Mean (%) ± SD (%) across brain regions investigated.
Time frame: 12 weeks
Population: The number of patients included in analyses is smaller than the total number of study participants due to study attrition and inability to tolerate the scanner.
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Internal Guidance Training (IG) | Percent Signal Change | 0 percentage of baseline BOLD signal | Standard Deviation 0 |
| Externally Guided Training (EG) | Percent Signal Change | 23 percentage of baseline BOLD signal | Standard Deviation 68 |
| Behavioral Control (BC) | Percent Signal Change | 35 percentage of baseline BOLD signal | Standard Deviation 44 |