HF-rTMS Primed Balance Training on Corticomotor Excitability, Balance, and Gait in Parkinson's
Effects of High-frequency Repetitive Transcranial Magnetic Stimulation-primed Balance Training on Corticomotor Excitability, Balance, and Gait Performance in Parkinson's Disease
Descripción general del estudio
Estado
Condiciones
Intervención / Tratamiento
Descripción detallada
This study plans to recruit 20 patients with Parkinson's disease. The experimental design is a double-blinded, randomized controlled trial, where neither the participants nor the evaluators will know the group assignments. All participants will receive rTMS "activation" followed by a modified Otago exercise program (balance training) specifically targeting Parkinson's disease. The intervention will last for 5 weeks, with sessions twice a week, totaling 10 treatments.
Before the intervention, participants will be randomly and evenly assigned to two groups: a high-frequency stimulation group (HF-rTMS) and a sham control group. This study will use the "Magstim Rapid² TMS system" for repetitive transcranial magnetic stimulation provided by the Department of Rehabilitation at Chung Shan Medical University Hospital.
For the sham control group, based on recommendations from previous related studies, participants will receive the same stimulation intensity as the experimental group, but the treatment coil will be placed on the head rotated by 90°, minimizing possible neurophysiological responses. This approach ensures a safe and humane experimental design.
Additionally, assessments will be conducted before the intervention, after all treatment sessions are completed, and at a one-month follow-up.
After completing the pre-test, the subjects will be randomly assigned to receive either high-frequency or sham rTMS treatment. The stimulation site is based on several recent systematic reviews and meta-analyses investigating the effects of repetitive transcranial magnetic stimulation on motor symptoms of Parkinson's disease (Conte D et al., 2025; Yang et al., 2018; Li et al., 2022), targeting the bilateral primary motor cortex for the lower limbs (M1-LL). The treatment lasts approximately 25 minutes. Immediately after the magnetic stimulation treatment, a 60-minute modified Otago exercise program (balance training) will be conducted. The balance training will be guided by a professional physical therapist.
Tipo de estudio
Inscripción (Estimado)
Fase
- No aplica
Criterios de participación
Criterio de elegibilidad
Edades elegibles para estudiar
- Adulto
- Adulto Mayor
Acepta Voluntarios Saludables
Descripción
Inclusion Criteria:
- Diagnosed with idiopathic PD
- Aged between 40-80 years
- Stable on antiparkinsonian medication ( > 3 months)
- H&Y I-III
- Able to walk continuously for at least 10 minutes
- The ability to follow commands and instructions
Exclusion Criteria:
- Neurological diseases other than PD
- Severe musculoskeletal, cardiopulmonary disorders
- MMSE < 24
- Contraindications for TMS
- Have undergone or are scheduled to undergo neurological surgery during the study participation period
Plan de estudios
¿Cómo está diseñado el estudio?
Detalles de diseño
- Propósito principal: Tratamiento
- Asignación: Aleatorizado
- Modelo Intervencionista: Asignación paralela
- Enmascaramiento: Doble
Armas e Intervenciones
Grupo de participantes/brazo |
Intervención / Tratamiento |
|---|---|
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Experimental: High-frequency rTMS + balance training
Frequency: 10 Hz; Intensity: 90% RMT; Duration: 4 seconds; Rest time: 26 seconds; Sets: 25; Number of pulses: 1000*2; Total time: 25 minutes Followed by an improved Otago exercise program (60 minutes)
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A painless, non-invasive, and well-tolerated non-pharmacological treatment method-Repetitive Transcranial Magnetic Stimulation (rTMS)-delivers repeated and systematic magnetic field stimulation to specific brain regions through a stimulation coil placed on the scalp.
These repeated magnetic pulses not only alter the excitability of the targeted area but also affect anatomically connected brain regions.
The parameters are as follows: Frequency: 10 Hz; Intensity: 90% RMT; Duration: 4 seconds; Rest: 26 seconds; Trains: 25 times; Pulses: 1000*2; Total time: 25 minutes.
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Comparador falso: Sham rTMS + balance training
The stimulation parameters were the same as those of the experimental group, with only the stimulation coil rotated 90° to minimize the neurophysiological effects. Followed by an improved Otago exercise program (60 minutes) |
In this study, the sham stimulation group was designed based on previous related research and expert recommendations.
Participants in this group will receive 20% of the stimulation intensity used in the treatment group, which is significantly lower than the treatment group's 90%, ensuring a safe and humane experimental design.
The parameters are as follows: Frequency: 10 Hz; Intensity: 20% RMT; Duration: 4 seconds; Rest: 26 seconds; Trains: 25 times; Pulses: 1000*2; Total time: 25 minutes.
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¿Qué mide el estudio?
Medidas de resultado primarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Corticospinal inhibition : Cortical silent period (CSP) (ms)
Periodo de tiempo: Baseline, week 5 and follow-up 1 month
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Cortical silent period (CSP) measured by Transcranial Magnetic Stimulation (TMS), with higher ms indicating stronger corticospinal inhibitory effect
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Baseline, week 5 and follow-up 1 month
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Intracortical inhibition : Short-interval intracortical inhibition (SICI) (%)
Periodo de tiempo: Baseline, week 5 and follow-up 1 month
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Short-interval intracortical inhibition (SICI) measured by Transcranial Magnetic Stimulation (TMS), with higher percentage indicating stronger intracortical inhibitory effect
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Baseline, week 5 and follow-up 1 month
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Mini-Balance Evaluation Systems Test (Mini-BESTest)
Periodo de tiempo: Baseline, week 5 and follow-up 1 month
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Mini-Balance Evaluation Systems Test (Mini-BESTest) is used to assess balance performance.
Total scores range from 0 to 28, with higher scores indicating better balance and functional mobility.
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Baseline, week 5 and follow-up 1 month
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Falls Efficacy Scale-International (FES-I)
Periodo de tiempo: Baseline, week 5 and follow-up 1 month
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Falls Efficacy Scale-International (FES-I) is used to assess confidence in balance.
Total scores range from 16 to 64, with higher scores indicating more balanced confidence
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Baseline, week 5 and follow-up 1 month
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Medidas de resultado secundarias
Medida de resultado |
Medida Descripción |
Periodo de tiempo |
|---|---|---|
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Gait speed (m/s) measured by GAITRite
Periodo de tiempo: Baseline, week 5 and follow-up 1 month
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Baseline, week 5 and follow-up 1 month
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Step length (m) measured by GAITRite
Periodo de tiempo: Baseline, week 5 and follow-up 1 month
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Baseline, week 5 and follow-up 1 month
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Movement Disorder Society-Unified Parkinson's Disease Rating Scale, Part III: Motor Examination (MDS-UPDRS-III)
Periodo de tiempo: Baseline, week 5 and follow-up 1 month
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MDS-UPDRS-III is used to assess motor symptoms in patients with Parkinson's disease.
Total scores range from 0 to 132, with higher scores indicating more severe motor symptoms.
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Baseline, week 5 and follow-up 1 month
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Colaboradores e Investigadores
Patrocinador
Fechas de registro del estudio
Fechas importantes del estudio
Inicio del estudio (Estimado)
Finalización primaria (Estimado)
Finalización del estudio (Estimado)
Fechas de registro del estudio
Enviado por primera vez
Primero enviado que cumplió con los criterios de control de calidad
Publicado por primera vez (Actual)
Actualizaciones de registros de estudio
Última actualización publicada (Actual)
Última actualización enviada que cumplió con los criterios de control de calidad
Última verificación
Más información
Términos relacionados con este estudio
Términos MeSH relevantes adicionales
Otros números de identificación del estudio
- CS2-26021
Información sobre medicamentos y dispositivos, documentos del estudio
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