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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:
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| PD APA training group | Experimental | Weight shift training and APA feedback. |
|
| PD PAS group | Experimental | Using PAS to regulate brain plasticity |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Weight shift training and APA feedback | Procedure | Use COP trajectory to train weight shift on force plate. To give APA visual feedback for subjects after weight shift training. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Balance Performance | Measured by the duration the stance or stand can be maintained. Unit：second(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. | 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：millimeter(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：millimeter per second(mm/s) | Baseline, 4 weeks and 8 weeks |
| COP Area in Balance Tasks |
| Measure | Description | Time Frame |
|---|---|---|
| Total UPDRS-III Score | 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. |
Inclusion Criteria:
- Clinical diagnosis of Parkinson disease.
Exclusion Criteria:
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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 |
|
|
| 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 millimeter(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 |
| Baseline |
| D009422 | Nervous System Diseases |
| D009069 | Movement Disorders |
| D000080874 | Synucleinopathies |
| D019636 | Neurodegenerative Diseases |