PAS Balance Training for Parkinson Disease (PD)

Official title

Effect of Combined PAS Balance Training on Individuals With PD

Overview

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.

Interventions

• Procedure 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.
• Procedure Paired associative stimulation
  Use TMS combine ES to stimulate TA nerve and M1 cortical

Primary outcome measures

• Balance Performance [Time frame: Baseline, 4 weeks and 8 weeks]
• COP Path Length in Balance Tasks [Time frame: Baseline, 4 weeks and 8 weeks]
• COP Displacement in Balance Tasks [Time frame: Baseline, 4 weeks and 8 weeks]
• Motor Evoked Potentials (MEPs) [Time frame: Baseline, 4 weeks and 8 weeks]
• Intracortical Facilitation (ICF) [Time frame: Baseline, 4 weeks and 8 weeks]
• Intracortical Inhibition (ICI) [Time frame: Baseline, 4 weeks and 8 weeks]
• Walking Speed [Time frame: Baseline, 4 weeks and 8 weeks]
• Step Length [Time frame: Baseline, 4 weeks and 8 weeks]
• Step Time [Time frame: Baseline, 4 weeks and 8 weeks]

Secondary outcome measures (7)

• COP Velocity in Balance Tasks [Time frame: Baseline, 4 weeks and 8 weeks]
• COP Area in Balance Tasks [Time frame: Baseline, 4 weeks and 8 weeks]
• Double Support Time [Time frame: Baseline, 4 weeks and 8 weeks]
• Single Support Time [Time frame: Baseline, 4 weeks and 8 weeks]
• Swing Time [Time frame: Baseline, 4 weeks and 8 weeks]
• Stance Time [Time frame: Baseline, 4 weeks and 8 weeks]
• Cadence [Time frame: Baseline, 4 weeks and 8 weeks]

Eligibility criteria

Inclusion criteria

\- Clinical diagnosis of Parkinson disease.

Exclusion criteria

• Musculoskeletal injuries on legs
• Osteoporosis.
• Any peripheral or central nervous system injury or disease patients.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

Taiwan · 1 center

• Chang Gung University — Taoyuan

Identifiers

NCT: NCT06598891 · PD_002

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗