PD - Parkinson's Disease
Conditions
Keywords
Gait Initiation, Paired associative stimulation (PAS), Balance training, Motor learning, Anticipatory postural adjustment (APA)
Brief summary
Gait initiation (GI) difficulty is a common problem in individuals with Parkinson's disease (PD), often linked to impaired anticipatory postural adjustments (APA). Currently, there are no targeted rehabilitation programs designed specifically for GI-related APA in PD patients. Research has shown that while motor learning deficits are common in PD, explicit learning is better preserved than implicit learning. Therefore, a GI-related APA training system using an explicit learning model could be particularly effective for this population. During motor learning, long-term potentiation (LTP) increases the excitability of the primary motor cortex. Paired associative stimulation (PAS) has been demonstrated to induce LTP-like changes in the motor cortex, making it a potential priming method to enhance motor learning. However, the priming effect of PAS targeted at leg muscles and the motor cortex on motor learning related to GI-APA has not been previously studied. The objectives of this study are: 1. To investigate the effects of explicit and implicit training on GI-related APA. 2. To evaluate the priming effect of PAS on GI-related APA training and the associated plasticity changes in the motor cortex.
Interventions
Use COP trajectory to train weight shift on force plate. To give APA visual feedback for subjects after weight shift training.
PROCEDUREPaired associative stimulation
Use TMS combine ES to stimulate TA nerve and M1 cortical
Sponsors
Chang Gung University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
20 Years to No maximum
Healthy volunteers
No
Inclusion criteria
\- Clinical diagnosis of Parkinson disease.
Exclusion criteria
* Musculoskeletal injuries on legs * Osteoporosis. * Any peripheral or central nervous system injury or disease patients.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Step Time | Baseline, 4 weeks and 8 weeks | The duration taken for one complete step, measuring from foot-off of one foot to the next foot-off of the same foot, usually expressed in seconds. |
| Balance Performance | Baseline, 4 weeks and 8 weeks | Measured by the duration the stance or stand can be maintained. Unit：second(s) |
| COP Path Length in Balance Tasks | Baseline, 4 weeks and 8 weeks | The total distance traveled by the COP over a specified period. Longer path lengths can indicate increased effort to maintain balance or greater instability. |
| COP Displacement in Balance Tasks | Baseline, 4 weeks and 8 weeks | Measures of COP movement in the anterior-posterior (AP) and medial-lateral (ML) directions, offering insights into the directional tendencies of balance control. Unit：millimeter(mm) |
| Motor Evoked Potentials (MEPs) | Baseline, 4 weeks and 8 weeks | MEPs are the electrical responses recorded from muscles following stimulation of the motor cortex. They reflect the efficiency of neural transmission from the cortex to the muscle. Unit：millivolts (mV) |
| Intracortical Facilitation (ICF) | Baseline, 4 weeks and 8 weeks | ICF is measured by applying a pair of TMS pulses with a short interval (e.g., 8-15 ms) where the first (subthreshold) pulse is followed by a second (suprathreshold) pulse, leading to an increased amplitude of the MEP. |
| Intracortical Inhibition (ICI) | Baseline, 4 weeks and 8 weeks | ICI is measured similarly to ICF but with a shorter inter-stimulus interval (e.g., 1-5 ms), resulting in a suppressed MEP amplitude. This suppression reflects inhibitory processes within the cortex. |
| Walking Speed | Baseline, 4 weeks and 8 weeks | The time taken by participants to walk a standardized distance, typically expressed in centimeters per second (cm/s). |
| Step Length | Baseline, 4 weeks and 8 weeks | The linear distance between the two ankles, typically expressed in centimeter(cm). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| COP Velocity in Balance Tasks | Baseline, 4 weeks and 8 weeks | The speed at which the COP moves, calculated over the duration of the balance task. Higher velocities may reflect more dynamic balance adjustments or instability. Unit：millimeter per second(mm/s) |
| COP Area in Balance Tasks | Baseline, 4 weeks and 8 weeks | The area covered by the COP trajectory during the balance task, providing an estimate of the sway envelope. A larger area might indicate poorer balance control. Unit：square millimeter(mm\^2) |
| Double Support Time | Baseline, 4 weeks and 8 weeks | The portion of the gait cycle where both feet are in contact with the ground, indicating the transition phase between steps, expressed as a percentage of the gait cycle or in seconds. |
| Single Support Time | Baseline, 4 weeks and 8 weeks | The duration within the gait cycle when only one foot is in contact with the ground, typically measured in seconds or as a percentage of the total gait cycle. |
| Swing Time | Baseline, 4 weeks and 8 weeks | The portion of the gait cycle where the foot is not in contact with the ground, moving forward to the next step. It is usually expressed as a percentage of the total gait cycle or in seconds. |
| Stance Time | Baseline, 4 weeks and 8 weeks | The portion of the gait cycle when the foot is in contact with the ground, supporting body weight. It's typically expressed as a percentage of the total gait cycle or in seconds |
| Cadence | Baseline, 4 weeks and 8 weeks | The number of steps an individual takes per minute, providing an overview of gait speed and rhythm, , expressed as steps per minute. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Total UPDRS-III Score | Baseline | The Unified Parkinson's Disease Rating Scale (UPDRS) Part III, also known as the UPDRS-III or the Motor Examination, is a critical component of the UPDRS used to assess the motor symptoms of Parkinson's disease (PD). To provide a comprehensive assessment of motor function in individuals with Parkinson's disease, covering aspects such as bradykinesia (slowness of movement), rigidity, tremors, and postural instability. The UPDRS-III consists of 14 items, each rated on a scale from 0 (normal) to 4 (severe), with a total possible score range from 0 to 108. Higher scores indicate greater motor impairment. |
Countries
Taiwan
Outcome results
None listed