Influence of Autonomy on Motor Learning in People With Parkinson's Disease

The goal of this clinical trial is to explore the benefits of autonomy supported learning in patients with Parkinson's disease. The main questions to answer are:

• Whether autonomy supported learning can benefit motor learning in PD patients
• Whether autonomy supported learning can enhance intrinsic motivation and/ or information processing of PD patients in learning a new task.
• Whether autonomy supported learning can facilitate cortical excitability change after practicing a new task.

Participants will be recruited into two groups (Self-control group, SC; and yoked group, YK) to learn a finger-pressing trajectory matching task

• Participants in SC group will have choice over feedback schedule during trial practice
• Participants in YK group will receive feedback with no-choice during trial practice Researchers will compare the retention test performance to see if autonomy supported learning will lead to better learning effect.

Study Overview

• Status: Recruiting
• Conditions: Parkinson Disease
• Intervention / Treatment: Behavioral: Autonomy supported learning; Behavioral: Practice with predetermined feedback

Detailed Description

Autonomy is the sense of learner to actively participate in determining their own behaviour. The present study aims to investigate whether an autonomy supported practice (with self-controlled feedback) would benefit adults with Parkinson's disease (PD), along with increased intrinsic motivation, information processing and cortical excitability. Two groups of healthy adults and two groups of PD patients will be recruited to learn a finger-pressing trajectory matching task. Participants will be allocated in either a self-control group (choice over feedback schedule), or a yoked group (receive feedback with no-choice). Learning will be assessed on the second day and one week later, along with an error estimation of learners' own performance to represent their information processing ability. Cortical excitability and inhibition will be assessed via transcranial magnetic stimulation as indicators of cortical plasticity. Questionnaire regarding motivation will be assessed before and after practice trials. Study hypothesized that individual with PD would benefit from autonomy supported learning, with better performance, enhanced motivation and information processing, associates with change of cortical excitability

• Study Type: Interventional
• Enrollment (Estimated): 72
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Ya-Yun Lee, PhD; Phone Number: +886-2-33668155; Email: yayunlee@ntu.edu.tw
• Study Contact Backup: Name: DE-JUN LIM, Bachelor; Phone Number: +886-9-66716146; Email: R11428011@ntu.edu.tw

Study Locations

• Taiwan
  • Taipei, Taiwan, 100229
    • Recruiting
    • National Taiwan University Hospital
    • Contact: Ya-Yun Lee, PhD; Phone Number: +886-2-33668155; Email: yayunlee@ntu.edu.tw

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• age above 20-years-old
• able to follow instructions to perform the tasks (Montreal Cognitive Assessment ≥ 24)
• no surgery and injury in upper extremities in recent 6 months

Exclusion Criteria:

• other neurological disorders in addition to Parkinson's disease
• Parkinson's disease dementia
• symptom of severe tremor in upper extremities (score ≥ 3 in Question 15 to 18 of UPDRS-III)
• deep brain stimulation or pacemaker implanted
• medical history of seizure
• a blood-relative with history of epilepsy
• unstable medical conditions
• pregnancy

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Self-control group; Participants will be able to choose over feedback schedule when practicing finger-pressing trajectory matching task.	Behavioral: Autonomy supported learning; The ability of learners to participate in determining their own behaviour, which is the feedback schedule regarding their practice performance in this study.
Active Comparator: Yoked group; Participants will receive feedback, which was determined by their counterpart in self-control group, with no-choice when practicing finger-pressing trajectory matching task.	Behavioral: Practice with predetermined feedback; Learners practice the motor task, while the feedback is provided according to their counterpartner

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Performance accuracy	Overall performance accuracy relative to the target waveform was assessed using root mean square error (RMSE), which is the mean difference between the target waveform and the participant's movement trajectory calculated over their actual movement time.	up to day 7

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Intrinsic Motivation Inventory	A questionnaire with subscales of perceived competence and autonomy. Questions were either taken directly or modified from the IMI, regarding to the participants subjective motivation after completing their practice trials.	day 1, day 2, day 7
Error Estimation	Participants will be instructed to estimate their error in RMSE after completing each trial in retention and transfer test. Error estimation is used to assess the cognitive processing of participants during the trials.	day 2, day 7
Cortical excitability changes	Transcranial magnetic stimulation (TMS) device (The Magstim Company Ltd, Whitland, UK) will be used to determine the neurophysiological changes of corticomotor excitability before and after the acquisition phase.	Baseline, day 2, day 7

Collaborators and Investigators

• Sponsor: National Taiwan University Hospital

Publications and helpful links

General Publications

• Carter MJ, Ste-Marie DM. Not all choices are created equal: Task-relevant choices enhance motor learning compared to task-irrelevant choices. Psychon Bull Rev. 2017 Dec;24(6):1879-1888. doi: 10.3758/s13423-017-1250-7.
• Chiviacowsky S, Wulf G, Lewthwaite R, Campos T. Motor learning benefits of self-controlled practice in persons with Parkinson's disease. Gait Posture. 2012 Apr;35(4):601-5. doi: 10.1016/j.gaitpost.2011.12.003. Epub 2011 Dec 30.

Study record dates

Study Major Dates

• Study Start (Actual): August 21, 2023
• Primary Completion (Actual): July 31, 2025
• Study Completion (Estimated): December 31, 2025

Study Registration Dates

• First Submitted: July 17, 2023
• First Submitted That Met QC Criteria: July 24, 2023
• First Posted (Actual): July 25, 2023

Study Record Updates

• Last Update Posted (Actual): November 18, 2025
• Last Update Submitted That Met QC Criteria: November 16, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Transcranial magnetic stimulation; Motor learning; Parkinson's disease; Autonomy
• Additional Relevant MeSH Terms: Synucleinopathies; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurodegenerative Diseases; Movement Disorders; Parkinsonian Disorders; Basal Ganglia Diseases; Parkinson Disease
• Other Study ID Numbers: 202304047RINC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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