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Our research focused on understanding the interplay between brain excitability and balance function in patients with Parkinson's disease (PD), alongside evaluating effective physical therapy methods. It highlights the prevalence of non-motor disorders and cognitive impairments among PD patients, including balance and postural issues, cognitive function decline, and gait instability. Additionally, it notes that PD patients exhibit abnormal electrophysiological responses, indicating altered central excitability.
Research on Brain Excitability and Balance Function Performance in Patients with Parkinson's Disease and Related Physical Therapy Methods
Research indicates that non-motor disorders and cognitive impairments are prevalent in most patients with Parkinson's disease. These include balance issues, postural instability, impaired cognitive functions like working memory and executive functions, and gait instability. Additionally, electrophysiological phenomena in Parkinson's disease patients reveal abnormal central excitatory and inhibitory responses compared to healthy individuals.
This experiment seeks to investigate the link between motor performance and brain excitability in patients with Parkinson's disease. Previous studies suggest that associative electrical stimulation, used to regulate sensorimotor information integration, can enhance brain excitability in both healthy individuals and those with Parkinson's disease. However, the optimal parameters for this stimulation remain uncertain.
Furthermore, balance exercise training can improve motor performance in Parkinson's disease patients. This study aims to determine if various designs of associative electrical stimulation parameters can help these patients achieve optimal brain excitability regulation. The combined approach of this stimulation and balance exercise training aims to maintain and improve the patients' functional performance, thereby enhancing the safety of their daily activities.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Stage 1:Healthy people | Experimental | To establish PAS baseline and reliability. |
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| Stage 2:PD people | Experimental | To establish stage 3 training protocol. |
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| Stage 3:PD people | No Intervention | Control group. | |
| Stage 3: PD APA training group | Experimental | Weight shift training and APA feedback. |
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| Stage 3:PD PAS group | Experimental | Using PAS to regulate brain plasticity |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Weight shift training and APA feedback | Other | Use COP trajectory to train weight shift on force plate. To give APA visual feedback for subjects after weight shift training. |
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| Measure | Description | Time Frame |
|---|---|---|
| Balance Performance | Measured by the duration the stance can be maintained. Unit：seconds(s) | Baseline, 4 weeks and 8 weeks. |
| COP Path Length in Balance Tasks | The total distance traveled by the COP over a specified period. Longer path lengths can indicate increased effort to maintain balance or greater instability. Unit：millimeters(mm) | Baseline, 4 weeks and 8 weeks. |
| COP Displacement in Balance Tasks | Measures of COP movement in the anterior-posterior (AP) and medial-lateral (ML) directions, offering insights into the directional tendencies of balance control. Unit：millimeters(mm) | Baseline, 4 weeks and 8 weeks. |
| Motor Evoked Potentials (MEPs) | 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) | Baseline, 4 weeks and 8 weeks. |
| Intracortical Facilitation (ICF) | 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. | Baseline, 4 weeks and 8 weeks. |
| Intracortical Inhibition (ICI) | 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. | Baseline, 4 weeks and 8 weeks. |
| Measure | Description | Time Frame |
|---|---|---|
| COP Velocity in Balance Tasks | 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：millimeters per second(mm/s) | Baseline, 4 weeks and 8 weeks. |
| COP Area in Balance Tasks |
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Health subjects:
Exclusion Criteria:
PD subjects:
Inclusion Criteria:
- Clinical diagnosis of Parkinson disease.
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Ya-Ju Chang, PhD | Contact | +88632118800 | 5515 | yjchang@mail.cgu.edu.tw |
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Chang Gung University | Recruiting | Taoyuan | 333 | Taiwan |
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| ID | Term |
|---|---|
| D010300 | Parkinson Disease |
| ID | Term |
|---|---|
| D020734 | Parkinsonian Disorders |
| D001480 | Basal Ganglia Diseases |
| D001927 | Brain Diseases |
| D002493 | Central Nervous System Diseases |
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| Paired associative stimulation | Procedure | Use TMS combine ES to stimulate TA nerve and M1 cortical |
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| Walking Speed | The time taken by participants to walk a standardized distance, typically expressed in centimeters per second (cm/s). | Baseline, 4 weeks and 8 weeks. |
| Step Length | The linear distance between the two ankles, typically expressed in centimeter(cm). | Baseline, 4 weeks and 8 weeks. |
| Step Time | 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. | 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 millimeters(mm^2) |
| Baseline, 4 weeks and 8 weeks. |
| Double Support Time | 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. | Baseline, 4 weeks and 8 weeks. |
| Single Support Time | 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. | Baseline, 4 weeks and 8 weeks. |
| Swing Time | 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. | Baseline, 4 weeks and 8 weeks. |
| Stance Time | 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 | Baseline, 4 weeks and 8 weeks. |
| Cadence | The number of steps an individual takes per minute, providing an overview of gait speed and rhythm, , expressed as steps per minute. | Baseline, 4 weeks and 8 weeks. |
| D009422 | Nervous System Diseases |
| D009069 | Movement Disorders |
| D000080874 | Synucleinopathies |
| D019636 | Neurodegenerative Diseases |