The Learning Effects of Attentional Strategy on Dual-task Walking in Patients With Parkinson's Disease: Behavioral Performance and Neural Plasticity

National Taiwan University

Status: Terminated

Conditions: Parkinson Disease

Treatments: Behavioral: [year1] dual-task training with task priority strategy; Behavioral: [year2-3] dual-task training with internal and external focus

Study type: Interventional

Funder types: Other

Identifiers

NCT03895125

201812110RINC

Details and patient eligibility

About

[year1]

1. To compare the effects of dual-task training with two different task priority instruction in people with Parkinson's disease and healthy controls on dual-task weight shifting performances.
2. Investigate the changes of brain activities and functional connectivity after dual-task training with different task priority instructions.

[year 2-3]

To investigate the learning effects of walking with internal/external focus on walking automaticity and brain plasticity in dual-task walking training for PD patients with/without freezing of gait.

Full description

Postural-suprapostural task is defined as postural control takes place while another concurrent task is being performed, belonging to dual-task paradigms. Effective dual-task training is important to patients with Parkinson disease (PD), because they often lose balance and fall in dual-task conditions. Attentional strategy includes 1) task-priority between postural and suprapostural tasks and 2) internal and external focus for the postural task, which is the critical factor for both dual-task control and motor learning. However, the appropriateness of attentional strategy has not been investigated in dual-task training in patients with PD. Besides, there is lack of neural evidence of brain plasticity for previous studies about dual-task training in patients with PD. With the uses of EEG, EMG and behavioral measures, the purpose of this 3-year research project is to investigate the differences in performance quality and intrinsic neural mechanisms of dual-task training in PD, by adopting task-priority strategy and internal/external strategy during weight-shifting and walking. In the first year, the investigators will characterize task-priority effect (posture-priority vs. supraposture-priority) on dual-task training, with a special focus on modulation of brain plasticity and muscle activity patterns in weight-shifting posture for patients with PD. In the second and third years, the learning effects of walking internal/external focus on walking automaticity and brain plasticity will be investigated in dual-task walking training for PD patients with/without freezing of gait. Besides, the transfer effects of dual-task learning will be also investigated on medication "off" state. The present project is expected to have significant contributions not only to gain a better insight to neural correlates of dual-task training with different attentional strategies under weight-shifting and walking, but to optimize treatment strategy for PD patients with balance or dual-tasking disturbances.

Enrollment: 1 patient

Sex: All

Ages: 40+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion and exclusion criteria

[year1]

Inclusion criteria:

1. For people with Parkinson's disease

   1. modified Hoehn & Yahr stage 2-3
   2. without dementia and able to follow instructions

2. For healthy controls

age and gender matched healthy subjects as control group

Exclusion criteria:

1. MMSE < 26
2. with other disease that may influence balance ability
3. with marked action and postural tremor

[year2-3] inclusion criteria:

1. idiopathic Parkinson's disease
2. modified Hoehn & Yahr stage 2-3
3. without marked action or postural tremor

exclusion criteria:

1. MMSE < 26
2. with other disease that may influence balance ability

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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1 participants in 4 patient groups

[year1] PD group

Experimental group

Treatment:

Behavioral: [year1] dual-task training with task priority strategy

[year1] healthy control group

Active Comparator group

Treatment:

Behavioral: [year1] dual-task training with task priority strategy

[year2-3] freezer

Experimental group

Treatment:

Behavioral: [year2-3] dual-task training with internal and external focus

[year2-3] non-freezer

Experimental group

Treatment:

Behavioral: [year2-3] dual-task training with internal and external focus