Motor Training in PD

VA Office of Research and Development

Status: Completed

Conditions: Parkinson Disease

Treatments: Behavioral: Behavioral Control (BC) Condition; Behavioral: Adapted Tango Dancing

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT02457832

N0870-W

Details and patient eligibility

About

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.

Full 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.

Enrollment: 87 patients

Sex: All

Ages: 40 to 70 years old

Volunteers: Accepts Healthy Volunteers

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

Trial design

Primary purpose: Supportive Care

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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87 participants in 4 patient groups

Internal guidance training (IG)

Experimental group

Description:

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.

Treatment:

Behavioral: Adapted Tango Dancing

Externally guided training (EG)

Experimental group

Description:

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.

Treatment:

Behavioral: Adapted Tango Dancing

Behavioral Control (BC)

Active Comparator group

Description:

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.

Treatment:

Behavioral: Behavioral Control (BC) Condition

Normal Control (NC)

No Intervention group

Description:

Age-matched controls without Parkinson's disease will come in for a single assessment including MRI.