Understanding How Movements Are Transferred From Task to Task in Parkinson's Disease

Neural Mechanism of Skill Transfer in Parkinson's Disease

The purpose of this study is to understand how a specific brain area, the Posterior Parietal Cortex (PPC), plays a role in movement transfer from walking on a split-belt treadmill (SBT) to walking on the ground in people with Parkinson's disease (PwPD).

Here, investigators will apply repeated transcranial magnetic stimulation (rTMS) to upregulate the PPC. Then, the differences in the gait parameters between pre- and post-interventions will be compared between the TMS-active and the TMS-sham.

Study Overview

• Status: Recruiting
• Conditions: PARKINSON DISEASE (Disorder)
• Intervention / Treatment: Other: Transcranial Magnetic Stimulation Active; Other: Transcranial Magnetic Stimulation Sham

Detailed Description

The split-belt training has been shown to modulate gait in PwPD, but the skill transfer from the SBT training to the overground walking is poorly understood.

In this project, the subjects will visit the lab on three occasions: day 1 is for the clinical assessment based on the questionnaires, the 10-Meter Walk Task, as well as finding TMS targets and thresholds for the tibialis anterior (TA) and first dorsal interosseous (FDI) muscles, day 2 and day 3 are for either rTMS-active or rTMS-sham intervention. The second and third visits will take place at least 48h a part to ensure that the rTMS effects are washed out between visits.

During these two visits, the participants will first perform pre-overground walking tests (3 minutes): straight walking, steering, and turning, followed by pre-SBT adaptation tests (4 minutes) where they will adapt their gait to the asymmetrical belt that changes every 30 seconds. After these walking tests, the threshold measured on the first day will be validated, and the cortical excitability of the PPC will be measured by using a dual-coil: one is over the TA hotspot, and the other is over the PPC. Then, rTMS or sham intervention will be performed, followed by measuring the cortical excitability of the PPC. Immediately after that intervention, the participants will train on the SBT for 30 minutes in total (with a one-minute break every 5 minutes) with the speed of the belt changing every 30 seconds. Following the SBT training, the participants will perform post-overground and post-SBT adaptation tests. Lastly, the cortical excitability of the PPC will be measured.

• Study Type: Interventional
• Enrollment (Estimated): 24
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Tomoha Ogawa, BA; Phone Number: 514-398-2488; Email: hbcl@mcgill.ca

Study Locations

• Canada
  • Quebec
    • Montreal, Quebec, Canada, H2W 1S4
      • Recruiting
      • McGill University - Currie Gymnasium
      • Contact: Tomoha Ogawa, BA; Phone Number: 514-398-2488; Email: hbcl@mcgill.ca
      • Principal Investigator: Caroline Paquette, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• a confirmed diagnosis of idiopathic Parkinson's disease
• absence of freezing of gait confirmed by a "No" answer to the second item of the New Freezing of Gait Questionnaire (NFOGQ) and no observation of FOG during a freezing provoking test
• no other neurological diagnosis
• no severe musculoskeletal/orthopedic or vestibular condition that interferes with walking and or significantly affects balance
• no mild cognitive impairment (Montreal Cognitive Assessment ≥ 25)
• able to walk independently and without assistive device for 30 minutes
• no previous experience with split-belt treadmill.

Exclusion Criteria:

• severe dyskinesia that interacts with walking and balance hearing or visual impairment
• observed inability to walk safely on a tied-belt treadmill
• neurological disorders other than PD or other pathology (e.g., orthopedic) interfering with mobility. - contradiction for TMS
• implanted deep brain stimulator.

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Other: Active rTMS First followed by Sham rTMS Second; Session 1: active rTMS (iTBS) over the right PPC Session 2: sham rTMS (iTBS) over the right PPC	Other: Transcranial Magnetic Stimulation Active; ACTIVE: intermittent Theta Burst Stimulation (a patterned form of rTMS). The participants will receive iTBS (50hz bursts at 5Hz for 600 pulses for a total duration of 3-minutes) over the right PPC at 80% RMT of the FDI.; Other: Transcranial Magnetic Stimulation Sham; SHAM: 2 coils on top of each other will be used instead of 1. The coil furthest to the head will be reversed. The coil on the head will not be stimulating but the reversed coil will (current directed away from the brain) with stimulate with the same parameters at the active stimulation (intermittent Theta Burst Stimulation (a patterned form of rTMS). The participants will receive iTBS (50hz bursts at 5Hz for 600 pulses for a total duration of 3-minutes) over the right PPC at 80% RMT of the FDI.
Other: Sham rTMS First followed by Active rTMS Second; Session 1: sham rTMS (iTBS) over the right PPC Session 2: active rTMS (iTBS) over the right PPC	Other: Transcranial Magnetic Stimulation Active; ACTIVE: intermittent Theta Burst Stimulation (a patterned form of rTMS). The participants will receive iTBS (50hz bursts at 5Hz for 600 pulses for a total duration of 3-minutes) over the right PPC at 80% RMT of the FDI.; Other: Transcranial Magnetic Stimulation Sham; SHAM: 2 coils on top of each other will be used instead of 1. The coil furthest to the head will be reversed. The coil on the head will not be stimulating but the reversed coil will (current directed away from the brain) with stimulate with the same parameters at the active stimulation (intermittent Theta Burst Stimulation (a patterned form of rTMS). The participants will receive iTBS (50hz bursts at 5Hz for 600 pulses for a total duration of 3-minutes) over the right PPC at 80% RMT of the FDI.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Stride length	The forward distance travelled by a foot during a gait cycle (cm) measured during overground walking and on the SBT with the Ambulatory Parkinson's Disease Monitoring (APDM) mobility lab system. A higher score indicates better gait control.	Day 2 and Day 3
Dual Support	The percentage of the gait cycle when both feet are in contact with the ground (%) will be measured during overground walking and on the SBT with the Ambulatory Parkinson's Disease Monitoring (APDM) mobility lab system. A higher score indicates a longer time for both feet to be in contact with the ground.	Day 2 and Day 3

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cadence	The number of steps per minute will be measured during overground walking and on the SBT with the Ambulatory Parkinson's Disease Monitoring (APDM) mobility lab system. A higher score indicates better gait control.	Day 2 and Day 3
Gait Speed	The speed of the subject, measured as the distance traveled in the gait cycle divided by the gait cycle duration (m/s) during overground walking and on the SBT will be measured with the Ambulatory Parkinson's Disease Monitoring (APDM) mobility lab system. A higher score indicates better gait control.	Day 2 and Day 3
Turning Velocity	The peak angular velocity of the turn (deg/s) during overground walking will be measured with the Ambulatory Parkinson's Disease Monitoring (APDM) mobility lab system. The higher score indicates better turning performance.	Day 2 and Day 3
Steps in turn	The number of steps taken in one turn during overground walking will be measured with the Ambulatory Parkinson's Disease Monitoring (APDM) mobility lab system. The higher score indicates better turning performance.	Day 2 and Day 3
Step length	The distance between the heels of two consecutive steps (m) during overground walking will be measured with a custom MATLAB script. The higher score indicates better gait control.	Day 2 and Day 3
Cortical Excitability	The cortical excitability will be assessed using a dual coil setup where two coils are placed on 2 different locations of the scalp at the same time. One coil will be positioned over the PPC, and the other over the TA hotspot. A total of 50 stimuli will be randomly delivered: 25 pulses will be applied solely over the TA hotspot (TA), and the other 25 paired pulses in which a PPC stimulus precedes the TA stimulus by 4 milliseconds (PPC + TA). Cortical excitability will be quantified by using the following ratio: (PPC + TA) / (TA). The higher score indicates the greater excitability of the neurons along the PPC-M1 pathway.	Day 2 and Day 3

Collaborators and Investigators

• Sponsor: McGill University
• Investigators: Principal Investigator: Caroline Paquette, PhD, McGill University

Study record dates

Study Major Dates

• Study Start (Actual): November 18, 2025
• Primary Completion (Estimated): May 1, 2026
• Study Completion (Estimated): May 1, 2026

Study Registration Dates

• First Submitted: September 26, 2025
• First Submitted That Met QC Criteria: January 9, 2026
• First Posted (Actual): January 20, 2026

Study Record Updates

• Last Update Posted (Actual): January 20, 2026
• Last Update Submitted That Met QC Criteria: January 9, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: Gait; Transcranial Magnetic Stimulation; Motor Adaptation; Split-belt Treadmill
• 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: 24-12-053

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: We have a data management plan in place but will make anonymized data available.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No