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

[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.

Study Overview

• Status: Terminated
• Conditions: Parkinson Disease
• Intervention / Treatment: Behavioral: [year1] dual-task training with task priority strategy; Behavioral: [year2-3] dual-task training with internal and external focus

Detailed 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.

• Study Type: Interventional
• Enrollment (Actual): 1
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Taipei, Taiwan, 10048
    • National Taiwan University Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 40 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

[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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

4

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: [year1] PD group	Behavioral: [year1] dual-task training with task priority strategy; postural focus: focus mainly on postural performances while dual-tasking suprapostural focus: focus mainly on suprapostural performances while dual-tasking
Active Comparator: [year1] healthy control group	Behavioral: [year1] dual-task training with task priority strategy; postural focus: focus mainly on postural performances while dual-tasking suprapostural focus: focus mainly on suprapostural performances while dual-tasking
Experimental: [year2-3] freezer	Behavioral: [year2-3] dual-task training with internal and external focus; internal focus: focus mainly on body movements external focus: focus mainly on object in the environment
Experimental: [year2-3] non-freezer	Behavioral: [year2-3] dual-task training with internal and external focus; internal focus: focus mainly on body movements external focus: focus mainly on object in the environment

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
postural performance	measuring the amount of body weight shifting (unit: kg)	about 36 seconds for each trial for a total of 25 minutes
suprapostural performance	measuring the rotation angle of box on the hand (unit: degree)	about 36 seconds for each trial for a total of 25 minutes
Walking speed	collecting by using the GAITRite electronic walkway (CIR systems, Inc. ,USA) 24 inches(61cm) wide and 192 inches (488cm, 16ft) long, total 18,432 sensor (unit: m/s)	about 10-20 seconds for each trial
Cadence	collecting by using the GAITRite (unit: step/s)	about 10-20 seconds for each trial
Gait symmetry	collecting single leg supporting time of right and left leg by using the GAITRite	about 10-20 seconds for each trial

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
electroencephalography (EEG)	to collect the brain activity (unit: uV)	about 36 seconds for each trial for a total of 25 minutes
electromyography (EMG)	to collect the muscle activity (unit: mV)	about 36 seconds for each trial for a total of 25 minutes

Collaborators and Investigators

• Sponsor: National Taiwan University Hospital
• Investigators: Principal Investigator: Cheng-Ya Huang, School & Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University

Study record dates

Study Major Dates

• Study Start (Actual): March 7, 2019
• Primary Completion (Actual): February 12, 2020
• Study Completion (Actual): February 12, 2020

Study Registration Dates

• First Submitted: March 13, 2019
• First Submitted That Met QC Criteria: March 27, 2019
• First Posted (Actual): March 29, 2019

Study Record Updates

• Last Update Posted (Actual): February 13, 2020
• Last Update Submitted That Met QC Criteria: February 11, 2020
• Last Verified: March 1, 2019

More Information

Terms related to this study

• Keywords: walking; EEG; Parkinson's disease; attention; dual-task training
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Parkinsonian Disorders; Basal Ganglia Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases; Parkinson Disease
• Other Study ID Numbers: 201812110RINC

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No