PAS Balance Training for Parkinson Disease (PD)

Condition(s) studied

Investigational drug(s) / intervention(s)

Weight shift training and APA feedback: Use COP trajectory to train weight shift on force plate. To give APA visual feedback for subjects after weight shift training.

Paired associative stimulation: Use TMS combine ES to stimulate TA nerve and M1 cortical

Study 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.

Eligibility

Primary outcome measure(s)

• 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).
• 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.

Trial sites (1)

More Chang Gung University trials in Taiwan

Other trials for the same condition