Neural Mechanism of Skill Transfer in Parkinson's Disease
Phase: NA
Conditions: PARKINSON DISEASE (Disorder)
Sponsor: McGill University

Official Title of the study: Neural Mechanism of Skill Transfer in Parkinson’s disease
June 19, 2025

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Neural Mechanism of Skill 
Transfer in Parkinson’s Disease  
 
Submission to McGill Faculty of Medicine IRB  
 
 
 

2 
contents 
Abbreviations.................................................................................................................................... 3 
Lay summary .................................................................................................................................... 4 
Objectives ..................................................................................................................................... 4 
Experimental approach ................................................................................................................. 4 
Relevance ...................................................................................................................................... 5 
Study purpose and rationale ............................................................................................................. 5 
Description of study population, inclusion and exclusion criteria ...................................................... 6 
Sample size and how it was determined............................................................................................. 6 
Design and description of methodology ............................................................................................. 7 
Clinical assessment (first visit) ...................................................................................................... 8 
Outcome measures ........................................................................................................................ 9 
rTMS procedure ........................................................................................................................... 9 
Definition of endpoints .................................................................................................................... 10 
Measurements and study instruments ............................................................................................. 11 
Data analysis plan ........................................................................................................................... 11 
Recruitment procedures .................................................................................................................. 12 
Details on confidentiality ......................................................................................................... 12 
Statement on ethical considerations .................................................................................................... 12 
Associated risk ............................................................................................................................ 13 
Summary of the budget ................................................................................................................... 13 
References ....................................................................................................................................... 13 
Appendices ..................................................................................................................................... 16 
 
 

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Abbreviations 
PD: Parkinson's disease 
SBT: Split-belt treadmill 
PwPD: Patients with Parkinson's disease 
PPC: Posterior parietal cortex  
TMS: Transcranial magnetic stimulation 
rTMS: Repetitive transcranial magnetic stimulation 
NFOGQ: New Freezing of Gai Questionnaire  
MOCA: Montréal Cognitive Assessment  
10MWT: 10 Meter Walk Test 
MDS-UPDRS: Movement Disorder Society-Unified Parkinson’s Disease Rating Scale  
FES: Falls efficacy scale  
HADS: Hospital Anxiety and Depression Scale 
SMA: Somatosensory motor area  
APDM: Ambulatory Parkinson’s Disease Monitoring  
MEPs: Motor evoked potentials 
FDI: First dorsal interosseous  
RMT: Resting motor threshold 
TBT: tide-belt treadmill  
TBS: theta burst stimulation 
iTBS: intermittent theta burst stimulation  
 
 
 
 
 

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Lay summary  
Parkinson’s disease (PD) is a neurological degenerative disorder that shows motor 
impairment (Wu et al., 2015) and cognitive dysfunction (Sarter et al., 2021). Motor 
impairment including the decrease in motor adaptation skills results in increased falls 
(Jacobsen & Ferris, 2024), highlighting the importance of addressing the decline in motor 
adaptation skills in patients with PD (PwPD). To improve the motor adaptation in PwPD, the 
split-belt treadmill (SBT), where each foot is driven at a different speed, has been used. 
Currently, the SBT training has been shown to modulate gait in PwPD (D'Cruz et al., 2020; 
Hulzinga et al., 2023; Roemmich et al., 2014), but the skill transfer from the SBT training to 
the overground walking is poorly understood (Hulzinga et al., 2023). In terms of brain 
regions involved in the process of SBT adaptation, the posterior parietal cortex (PPC) has 
been found to play an important role in visuomotor integration and error monitoring (Shin et 
al., 2009) (Gwin et al., 2011), critical for overground walking. Furthermore, less activation of 
PPC has been reported in PwPD with freezing of gait symptom (Mitchell et al., 2019). 
Therefore, for this project, we propose to upregulate the PPC with non-invasive brain 
stimulation prior to SBT training to determine the role of the PPC on SBT gait adaptation.  
Objectives  
1. Determine the effect of the upregulation of PPC on SBT gait adaptation skill 
transfer from the treadmill to overground walking in PwPD. 
2. Determine the effect of PPC upregulation on the training effects of SBT in PwPD. 
Experimental approach  
24 participants will participate in this study. Participants will take part in a three-visit 
protocol. The first visit will consist of a general clinical assessment and screening for 
participation. The other two visits will consist of rTMS over PPC (real or sham) + SBT 
training intervention, presented in random (i.e. real or sham rTMS stimulation over the PPC) 
order and counterbalanced among subjects. These interventions will be preceded and 
followed by an overground gait tests and the treadmill adaptation tests. To investigate how 
the rTMS over PPC affects the gait adaptation skill transfer, the gait parameters will be 
compared between the SBT adaptation tests and the overground walking tests after the 
intervention. Also, to investigate how the rTMS over PPC affects the SBT training outcomes, 
the gait parameters on the SBT adaptation tests and in the overground walking tests will be 
compared before and after the intervention. 
 
Hypotheses 

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From a mechanistic point of view: 
• 
If upregulation of PPC facilitates the skill transfer from the SBT adaptation tests 
to the overground walking tests, the activation of the PPC might contribute to 
the gait adaptation skill transfer in PwPD. 
• 
If upregulation of PPC improves the SBT training effect, the PPC might 
contribute to the gait adaptation skill in PwPD. 
 
Based on previous literature: 
• 
Because the PPC has been shown to contribute to visuomotor integration and 
error monitoring required for complex walking(Gwin et al., 2011; Shin et al., 
2009) and decrease its activation during steering of gait in PwPD with freezing 
of gait (Mitchell et al., 2019), it is hypothesized that upregulation of the PPC 
will facilitate the SBT training effects, as well as its transfer to overground 
walking.  
 
Relevance  
To define appropriate therapeutic interventions to improve the motor adaptation deficit in 
PwPD, it is critical to demonstrate that the skills acquired from the interventions can be 
transferred to real-life situations. The data gained from this protocol will allow us to 
investigate the skill transfer from the SBT training to real-life walking. Also, it will provide 
key information on the potential role of PPC on gait adaptation as well as skill transfer, that 
will benefit further work on discovering the brain mechanisms related to human gait and skill 
transfer.  
 
Study purpose and rationale  
PwPD show motor adaptation impairments that lead to increases in falls (Jacobsen & Ferris, 
2024). Although training on the SBT has been proposed to improve motor adaptation skills 
(D'Cruz et al., 2020; Roemmich et al., 2014) and retention (Hulzinga et al., 2023) in PwPD, 
the investigation of skill transfer from the SBT to the overground complex walking has been 
limited. The PPC brain region has been proposed to integrate visuomotor information and 
monitor errors to guide motor programs (Shin et al., 2009) (Gwin et al., 2011), critical for 
complex walking. Also, we have shown that upregulation of the PPC can improve the 
freezing of gait symptom in PwPD (Potvin-Desrochers et al., 2023).  
Therefore, the aim of this project is to:  

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• 
Investigate the effect of the upregulation of PPC on the gait adaptation skill 
transfer from the adaptation task on the SBT to overground walking tasks 
such as straight walking, steering, and turning. 
• 
Investigate the effect of the upregulation of PPC on SBT training outcomes 
on the SBT as well as in the overground.  
Description of study population, inclusion and exclusion criteria  
For this study, 24 patients with PD will be recruited based on the following inclusion and exclusion 
criteria.  
Inclusion criteria: 1) a confirmed diagnosis of idiopathic Parkinson's disease, 2) being aged 50 and 
above 3) 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, 4) no other neurological diagnosis, 5) no severe musculoskeletal/orthopedic or vestibular 
condition that interferes with walking and or significantly affects balance, 6) no mild cognitive 
impairment (MOCA ≥ 25), 7) able to walk independently and without assistive device for 30 minutes, 
8) no previous experience with split-belt treadmill. Exclusion criteria: 1) severe dyskinesia that 
interacts with walking and balance, 2) hearing or visual impairment, 3) observed inability to walk 
safely on a tied-belt treadmill. 4) neurological disorders other than PD or other pathology (e.g., 
orthopedic) interfering with mobility. 5) contradiction for TMS, 6) implanted deep brain stimulator. 
 
Recruitment:  
Participants will first be recruited through our laboratory’s bank of participants (people who 
participated in previous studies in our laboratory and gave their consent for future contact; IRB 
Studies: A10-B96-22B and A08-B49-19A), or through the Quebec Parkinson Network.  
 
We estimate that the rate of recruitment should be at least 12 patients per month, without difficulty. 
Thus, the recruitment period for 24 PD patients should approximately 2 months.  
 
Sample size and how it was determined  
The sample size was calculated by using G*Power version 3.1.9.7 (Faul et al., 2007). Based on the 
calculation, 24 participants are required to obtain 80% power, at a level of significance of 95% 
(α=.05), and effect size f = 0.25 (moderate). The effect size was decided based on previous research 
which found the statistically significant intervention effect of the SBT with medium to high effect size 
in the PwPD (Hulzinga et al., 2023) (Seuthe et al., 2020).  

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Participants attrition: Some personal or technical issues may prevent us from collecting data (e.g., 
drop-out before the completion of the experiments). Therefore, we could recruit up to 3 additional 
participants (~10% of our desired sample size) to ensure that we reach our full sample size.  
Design and description of methodology 
This study is designed as a randomized controlled crossover and single-blind study. Participants 
will be required to visit the Human Brain Control of Locomotion Lab (HBCL) at McGill University 
on three occasions. During the first day, participants will go through a clinical assessment and 
determine their baseline walking speed using walking ability and gait speed using the 10-Meter Walk 
Test (10MWT). The rTMS targets will be identified and motor thresholds will be obtained. The 
second and third visits, will take place at least 48h a part to ensure that the rTMS effects are washed-
out between visits. As illustrated in Figure 1, during these two visits, the participants will first perform 
pre-overground walking tests: straight walking, steering, and turning, followed by pre-SBT adaptation 
tests. After these gait tests, motor threshold validation will be conducted to determine optimal rTMS 
stimulation, followed the rTMS or sham intervention. The order of the sham and rTMS will be 
randomized and counterbalanced among subjects. Immediately after the rTMS or sham intervention, 
patients will move to the split-belt treadmill for the 6 blocks (5 minutes for each block) of SBT 
training with a 1-minute break in between to prevent the effects of fatigue. After the SBT 
interventions, post-SBT adaptation tests and the post-overground walking tasks will be performed. 
Cortical excitability will be measured to investigate the change in the excitability of PPC before and 
after the TMS intervention (as shown by orange arrows in Figure 1). 
 
 
FIGURE 1. Protocol design for visits 2 and 3. Pre-overground and pre-SBT adaptation tests will be 
performed before the intervention. The order of the sham and rTMS will be randomized and 
counterbalanced among subjects. After the 6 blocks of SBT training, post-SBT adaptation and post-
overground tests will be completed. Orange arrows indicate cortical excitability measurements.  
 

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Clinical assessment (first visit) 
In the first visit, we will first review the consent form with the participants to ensure that participants 
have the capacity to consent. We will ask questions to ensure that they understand the information in 
the consent form and appreciate the experimental procedure and possible consequences, that they can 
reason, and that they can express a choice. If there are any questions concerning the ability of 
participants to provide consent, we will exclude the participant and terminate participation in the 
study. Several assessments will be performed to gain demographic information and rate the PD-
associated level of impairment, which include the following:  
• Freezing of gait status, and severity using the New Freezing of Gait Questionnaire 
(NFOGQ) (Nieuwboer et al., 2009);  
• Parkinson’s disease severity and stage using the MDS-Unified Parkinson's Disease Rating 
Scale (MDS-UPDRS- part III)(Goetz et al., 2008) and Hoen and Yahr scale (Goetz et al., 
2004);  
• Global cognition using the Montreal Cognitive Assessment (MOCA) (Nasreddine et al., 
2005);  
• Fear of falling using the Tinetti Falls Efficacy Scale (Tinetti FES) (Tinetti et al., 1990);  
• Ratings of anxiety and depression using Hospital Anxiety and Depression Scale (HADS) 
(Snaith, 2003);  
• Walking ability and gait speed using the 10 Meter Walk Test (10MWT);  
• Participant demographic information, such as gender (GENESIS PRAXIS questionnaire), 
age, and body mass will be collected.  
• PD medication and dosage to calculate the levodopa equivalent dose using established 
methods (Tomlinson et al., 2010). 
Finally, through these clinical assessments, participants will be screened for a history of seizures, 
other existing neurological disorders, or other severe health conditions.  
 
Gait tasks (second and third visit) 
The pre- and post-overground walking tests consist of straight walking, steering, and turning tasks. 
Presentation of these tasks will be randomized across subjects. For the pre-and post-SBT 
adaptation tests, the three different SBT ratios; 25% (SBT25), 50% (SBT50), and 75%(SBT75) of 
the baseline walking speed measured on the 1 Visit will be applied to either leg, meaning there are 6 
different SBT conditions (3 SBT ratios x 2 legs). These six conditions will be randomly ordered and 
fixed among subjects. The SBT conditions will be changed every 30 seconds and be preceded and 
followed by the 30 seconds of tide-belt treadmill (TBT) baseline walking, meaning two belts set at the 
baseline speed (fig.2). The SBT training consists of 6 blocks, each for 5 minutes, and 1 minute break 

9 
in between. The same 6 conditions as the ones used in the pre- and post-adaptation tests will be 
applied and changed every 30 seconds without notifying participants. We will change the ratio 
continuously to examine gait adaptation to the split-belt, a protocol we have used previously (IRB 
Study: A11-M109-12B and published(Hinton et al., 2019) )However, the order of the ratio will differ 
from the one used in the pre- and post-adaptation tests and will be fixed among subjects. During the 
gait tests both on the SBT and in the overground, participants will wear binaural over-ear headphones 
that play pure white noise while walking to prevent auditory input coming from the different speed 
ratios.  
FIGURE 2. The example of a protocol design for the pre-and post-adaptation tests. The random order 
will be applied to the SBT ratios, and the order will be fixed among subjects. The ratios will be 
changed to another every 30 seconds. _R means the ratio will be applied to the right leg, and _L 
means the ratio will be applied to the left leg. 
 
Outcome measures  
Up to seven inertial sensors, specifically Ambulatory Parkinson’s Disease Monitoring (APDM) (Opal, 
Portland, OR, USA) will be affixed to measure gait parameters; stride length, cadence, and the 
proportion of the gait cycle spent in dual support for the SBT adaptation tests and the overground 
walking tests, and gait speed, turning speed, and steps per turn for the overground walking tests. 
 
rTMS procedure   
The rTMS procedure in this study will follow the method that has been approved by McGill IRB (IRB 
study number: A08-B49-19A and published(Potvin-Desrochers et al., 2023)). TMS will be delivered 
to the participants while comfortably seated, using a Super Rapid 2 TMS system (Magstim Company, 
UK) connected with a 70-mm figure of eight-shaped coil. A BrainSight frameless stereotaxic 
neuronavigation system (Rogue Research Inc, Montreal, Canada) will be used to mark the location of 
the stimulation points. The right PPC will be targeted with intermittent Theta Burst Stimulation 
(iTBS), a patterned form of rTMS, characterized by 2-second periods of 50 Hz bursts, repeated every 
10 seconds for a total of 600 pulses (Huang et al., 2005). The targeted coordinates for the PPC are 
38.4, -67.2, and 46.3 (x, y, z) (Koch et al., 2011), aiming at the inferior parietal lobe. Considering that 
we will be setting our target on the MNI template, the exact location of stimulation will vary across 

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participants. During stimulation the coil will be orientated tangentially to the scalp and 10° from the 
midline (Ku et al., 2015). For the sham stimulation, a second 50 mm figure-of-eight coil will be 
placed between the scalp and the stimulating coil. The upper coil will be turned upside-down to make 
stimulation to the cortex negligible, while preserving the sound and some of the sensation of vibration 
on the head. The stimulation will be delivered at 80% of FDI AMT away from the PPC(Potvin-
Desrochers et al., 2023). iTBS will be administered at 75% of RMT (Chung et al., 2018). Because the 
PPC is a non-motor region, we will use motor thresholds of the FDI representation as both these 
regions lie at a similar depth under the scalp and as we have used previously. During the first visit, the 
location of the FDI will be identified by probing the hand motor region of the cortex. The hotspot will 
be considered the location of the right primary motor cortex that elicits 2 consecutive motor evoked 
potentials (MEPs) in the relaxed right first dorsal interosseous (FDI) muscle with greater amplitude 
than the surrounding positions. Resting motor threshold (RMT) will be determined as the minimum 
TMS intensity required to elicit a MEP of 0.05mV in the resting FDI in at least 10 of 20 trials (Rossini 
et al., 2015). RMT will be quantified at each visit and used to calibrate iTBS intensity. Disposable 
surface electrodes (Biopac Systems, Inc.), placed in a belly-tendon mount, will be used to record the 
electromyographic (EMG) activity of the FDI. EMG signal will be recorded with a Biopac MP150 
acquisition system, sampled at 10kHz on a 16-bit analog-to-digital board, amplified and bandpass 
filtered (10-5000Hz). 
Cortical excitability  
The 25 TMS pulses will be applied over the tibialis anterior (TA) cortical motor representation with 
the 50 mm dome coil. The stimulation intensity will be set to elicit 1 mV MEPs at baseline and fixed 
through all sessions. In 25 additional trials, a conditioning stimulus to the PPC will be added 4 
milliseconds before the TM pulses with a 25 mm figure-of-eight coil in a dual coil set-up (PPC + TA). 
The stimulation will be set at 90% of the FDI RMT. TA and PPC + TA stimulus will be randomly 
intermixed and delivered using two Magstim 2002 stimulators(Potvin-Desrochers et al., 2023).  
To reduce inter-session variability, each session will be carried out at the same time of the day for 
each participant. The use of the neuronavigation system also reduces this variability since the different 
stimulation sites will be saved and used during the different conditions. We will also ensure that the 
participants keep a similar position between the different sessions.  
 
Definition of endpoints 
The study endpoints will be differences in gait kinematics to SBT adaptation pre-post intervention for 
each stimulation condition. 
 

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Measurements and study instruments  
TMS equipment and the SBT are available in our laboratory and we have experience with these 
protocols and patient population (TMS: IRB study number: A08-B49-19A and published(Potvin-
Desrochers et al., 2023), SBT: IRB Study: A11-M109-12B and published(Hinton et al., 2019)) .  
 
Clinical assessment will be conducted using a series of tests and questionnaires attached as 
appendices: 
 
 
• 
Health Questionnaire (PD) 
• 
GENESIS PRAXY Gender Questionnaire (EN/FR) 
• 
Edingburgh Handedness Inventory (EN/FR) 
• 
Waterloo Footedness Questionnaire  
• 
MDS-UPDRS-part Ⅲ (administered by the researcher) 
• 
Hoen and Yahr scale (administered by the researcher) 
• 
MOCA (administered by the participants) 
• 
FES (administered by the participants) 
• 
HADS (administered by the participants) 
• 
10MWT (gait performance) 
 
Data analysis plan  
The kinematic data of the pre-and post-SBT adaptation tests will be averaged over 4 minutes. Then, 
the stride length and dual support symmetry will be calculated by utilizing the following equation: 
symmetry = (right leg-left leg)/(right leg + left leg)(Malone & Bastian, 2010). For the cortical 
excitability, PPC + TA ratio will be obtained based on the following calculation(Potvin-Desrochers et 
al., 2023): (PPC + TA) / (TA). Factorial repeated measures ANOVA will test the change in the stride 
length and dual support symmetry between the SBT and the overground, and between rTMS and sham 
in the post-test (SBT x overground, rTMS x sham) (1), as well as the changes in the gait parameters in 
the overground walking tests (2) and in the SBT adaptation tests (3) between sham and rTMS (pre x 
post, rTMS x sham) (fig.3). The symmetry on the overground for (1) will be calculated from the first 
30 seconds of the TBT treadmill. In addition, factorial repeated measures ANOVA will test the 
differences in PPC + TA ratio (pre x post, rTMS x sham) to verify the effect of rTMS over PPC. 

12 
 
FIGURE 3. The plan for the data analysis. Factorial repeated measures ANOVA will test the 
differences in the stride length and dual support symmetry in the post-tests (SBT x overground, rTMS 
x sham) and the change in the symmetry and gait parameters: cadence, gait speed, turning speed, and 
steps per turn between pre-and post-interventions (pre x post, rTMS x sham). 
 
Recruitment procedures  
Firstly, we will recruit participants from our laboratory’s bank of participants (people who participated 
in the previous study in our laboratory and gave their consent for future contact, IRB study number: 
A08-B49-19A and A11-M109-12B), and then from the Quebec Parkinson Network. 
 
Details on confidentiality  
At all times, participants’ personal and identifying information will be kept confidential and under 
lock and key. During data analysis and documentation, participants will be identified only by their 
unique identification number. The recorded data by computers will be transferred and kept on a server 
located within McGill facilities with limited access to the members of the research team. All 
information, including the consent for the future study, will be kept for 7 years before destruction. 
Results from this study will be analyzed in group form. The outcomes will not contain the patient’s 
name or any potentially identifying information and will only appear in the form of a scientific 
presentation. 
 
Statement on ethical considerations  
This study will be conducted according to the ethical principles stated in the Declaration of Helsinki 

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(2013). Ethics approval will be obtained before initiating the study. Consent forms will take into 
consideration the well-being, free-will and respect of the participants, including respect of privacy. We 
agree to respect the requirements of the McGill University Faculty of Medicine Institutional Review 
Board, the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans, 1998 
(updated 2018) and the FRSQ Standards on ethics involving research and scientific integrity. 
 
Associated risk  
As mentioned before, the TMS application used in this research will follow the method used in our 
lab previously (Potvin-Desrochers et al., 2023) (IRB study number: A08-B49-19A). Because that 
study did not find any adverse effect, the risk of using rTMS with this protocol is low. Furthermore, 
there has been no report about the long-lasting side effects of rTMS, and the risk of TBS has been 
reported to be comparable and even less considerable than other high frequency of rTMS protocol 
(Oberman et al., 2011). Although the most common adverse effect is neck pain and transient 
headache, which affected 3% of the subjects undergoing TBS, the percentage is smaller compared to 
that for traditional high-frequency rTMS, 40% (Oberman et al., 2011). 
 
For the SBT, our laboratory has experience with the use of the SBT and has one published paper 
where the ratios of the SBT are changed constantly (Hinton et al., 2019). Furthermore, to prevent 
participants from falling, a safety harness will be used, as previously done in our laboratory (Hinton et 
al., 2019). 
Summary of the budget  
Participants will be compensated for their transportation (i.g. bus/metro ticket, taxi, mileage) if 
needed, and will be given 40$ for their participation. Thus, we estimate a cost of 960$ for this 
research. Funds from an NSERC grant to Caroline Paquette will be used to cover these expenses.  
References 
Chung, S., Rogasch, N. C., Hoy, K. E., Sullivan, C., Cash, R., & Fitzgerald, P. B. (2018). Impact of 
different intensities of intermittent theta burst stimulation on the cortical properties during 
TMS‐EEG and working memory performance. Human Brain Mapping, 39, 783 - 802.  
D'Cruz, N., Seuthe, J., Ginis, P., Hulzinga, F., Schlenstedt, C., & Nieuwboer, A. (2020). Short-Term 
Effects of Single-Session Split-Belt Treadmill Training on Dual-Task Performance in 
Parkinson's Disease and Healthy Elderly. Front Neurol, 11, 560084. 
https://doi.org/10.3389/fneur.2020.560084  
Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power 

14 
analysis program for the social, behavioral, and biomedical sciences. Behavior Research 
Methods, 39(2), 175-191. https://doi.org/10.3758/BF03193146  
Goetz, C. G., Poewe, W., Rascol, O., Sampaio, C., Stebbins, G. T., Counsell, C., Giladi, N., Holloway, 
R. G., Moore, C. G., Wenning, G. K., Yahr, M. D., Seidl, L., & Movement Disorder Society 
Task Force on Rating Scales for Parkinson's, D. (2004). Movement Disorder Society Task 
Force report on the Hoehn and Yahr staging scale: status and recommendations. Mov Disord, 
19(9), 1020-1028. https://doi.org/10.1002/mds.20213  
Goetz, C. G., Tilley, B. C., Shaftman, S. R., Stebbins, G. T., Fahn, S., Martinez-Martin, P., Poewe, W., 
Sampaio, C., Stern, M. B., Dodel, R., Dubois, B., Holloway, R., Jankovic, J., Kulisevsky, J., 
Lang, A. E., Lees, A., Leurgans, S., LeWitt, P. A., Nyenhuis, D.,…Movement Disorder 
Society, U. R. T. F. (2008). Movement Disorder Society-sponsored revision of the Unified 
Parkinson's Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing 
results. Mov Disord, 23(15), 2129-2170. https://doi.org/10.1002/mds.22340  
Gwin, J. T., Gramann, K., Makeig, S., & Ferris, D. P. (2011). Electrocortical activity is coupled to gait 
cycle phase during treadmill walking. Neuroimage, 54(2), 1289-1296. 
https://doi.org/10.1016/j.neuroimage.2010.08.066  
Hinton, D. C., Thiel, A., Soucy, J. P., Bouyer, L., & Paquette, C. (2019). Adjusting gait step-by-step: 
Brain activation during split-belt treadmill walking. Neuroimage, 202, 116095. 
https://doi.org/10.1016/j.neuroimage.2019.116095  
Huang, Y. Z., Edwards, M. J., Rounis, E., Bhatia, K. P., & Rothwell, J. C. (2005). Theta burst 
stimulation of the human motor cortex. Neuron, 45(2), 201-206. 
https://doi.org/10.1016/j.neuron.2004.12.033  
Hulzinga, F., Seuthe, J., D'Cruz, N., Ginis, P., Nieuwboer, A., & Schlenstedt, C. (2023). Split-Belt 
Treadmill Training to Improve Gait Adaptation in Parkinson's Disease. Mov Disord, 38(1), 
92-103. https://doi.org/10.1002/mds.29238  
Jacobsen, N. A., & Ferris, D. P. (2024). Exploring Electrocortical Signatures of Gait Adaptation: 
Differential Neural Dynamics in Slow and Fast Gait Adapters. eNeuro, 11(7). 
https://doi.org/10.1523/ENEURO.0515-23.2024  
Koch, G., Cercignani, M., Bonni, S., Giacobbe, V., Bucchi, G., Versace, V., Caltagirone, C., & 
Bozzali, M. (2011). Asymmetry of parietal interhemispheric connections in humans. J 
Neurosci, 31(24), 8967-8975. https://doi.org/10.1523/JNEUROSCI.6567-10.2011  
Koch, G., Cercignani, M., Pecchioli, C., Versace, V., Oliveri, M., Caltagirone, C., Rothwell, J., & 
Bozzali, M. (2010). In vivo definition of parieto-motor connections involved in planning of 
grasping movements. Neuroimage, 51(1), 300-312. 
https://doi.org/10.1016/j.neuroimage.2010.02.022  
Ku, Y., Zhao, D., Hao, N., Hu, Y., Bodner, M., & Zhou, Y. D. (2015). Sequential roles of primary 
somatosensory cortex and posterior parietal cortex in tactile-visual cross-modal working 
memory: a single-pulse transcranial magnetic stimulation (spTMS) study. Brain Stimul, 8(1), 

15 
88-91. https://doi.org/10.1016/j.brs.2014.08.009  
Malone, L. A., & Bastian, A. J. (2010). Thinking about walking: effects of conscious correction versus 
distraction on locomotor adaptation. J Neurophysiol, 103(4), 1954-1962. 
https://doi.org/10.1152/jn.00832.2009  
Mitchell, T., Potvin-Desrochers, A., Lafontaine, A. L., Monchi, O., Thiel, A., & Paquette, C. (2019). 
Cerebral Metabolic Changes Related to Freezing of Gait in Parkinson Disease. J Nucl Med, 
60(5), 671-676. https://doi.org/10.2967/jnumed.118.218248  
Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V., Collin, I., Cummings, 
J. L., & Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening 
tool for mild cognitive impairment. J Am Geriatr Soc, 53(4), 695-699. 
https://doi.org/10.1111/j.1532-5415.2005.53221.x  
Nieuwboer, A., Rochester, L., Herman, T., Vandenberghe, W., Emil, G. E., Thomaes, T., & Giladi, N. 
(2009). Reliability of the new freezing of gait questionnaire: agreement between patients with 
Parkinson's disease and their carers. Gait Posture, 30(4), 459-463. 
https://doi.org/10.1016/j.gaitpost.2009.07.108  
Oberman, L., Edwards, D., Eldaief, M., & Pascual-Leone, A. (2011). Safety of Theta Burst 
Transcranial Magnetic Stimulation: A Systematic Review of the Literature. Journal of 
Clinical Neurophysiology, 28(1), 67-74. https://doi.org/10.1097/WNP.0b013e318205135f  
Potvin-Desrochers, A., Martinez-Moreno, A., Clouette, J., Parent-L'Ecuyer, F., Lajeunesse, H., & 
Paquette, C. (2023). Upregulation of the parietal cortex improves freezing of gait in 
Parkinson's disease. J Neurol Sci, 452, 120770. https://doi.org/10.1016/j.jns.2023.120770  
Roemmich, R. T., Nocera, J. R., Stegemoller, E. L., Hassan, A., Okun, M. S., & Hass, C. J. (2014). 
Locomotor adaptation and locomotor adaptive learning in Parkinson's disease and normal 
aging. Clin Neurophysiol, 125(2), 313-319. https://doi.org/10.1016/j.clinph.2013.07.003  
Rossini, P. M., Burke, D., Chen, R., Cohen, L. G., Daskalakis, Z., Di Iorio, R., Di Lazzaro, V., Ferreri, 
F., Fitzgerald, P. B., George, M. S., Hallett, M., Lefaucheur, J. P., Langguth, B., Matsumoto, 
H., Miniussi, C., Nitsche, M. A., Pascual-Leone, A., Paulus, W., Rossi, S.,…Ziemann, U. 
(2015). Non-invasive electrical and magnetic stimulation of the brain, spinal cord, roots and 
peripheral nerves: Basic principles and procedures for routine clinical and research 
application. An updated report from an I.F.C.N. Committee. Clin Neurophysiol, 126(6), 1071-
1107. https://doi.org/10.1016/j.clinph.2015.02.001  
Sarter, M., Avila, C., Kucinski, A., & Donovan, E. (2021). Make a Left Turn: Cortico-Striatal 
Circuitry Mediating the Attentional Control of Complex Movements. Mov Disord, 36(3), 535-
546. https://doi.org/10.1002/mds.28532  
Seuthe, J., D'Cruz, N., Ginis, P., Becktepe, J. S., Weisser, B., Nieuwboer, A., & Schlenstedt, C. (2020). 
The Effect of One Session Split-Belt Treadmill Training on Gait Adaptation in People With 
Parkinson's Disease and Freezing of Gait. Neurorehabil Neural Repair, 34(10), 954-963. 
https://doi.org/10.1177/1545968320953144  

16 
Shin, S., Crapse, T. B., Mayo, J. P., & Sommer, M. A. (2009). Visuomotor Integration. In M. D. 
Binder, N. Hirokawa, & U. Windhorst (Eds.), Encyclopedia of Neuroscience (pp. 4354-4359). 
Springer Berlin Heidelberg. https://doi.org/10.1007/978-3-540-29678-2_6384  
Snaith, R. (2003). The Hospital Anxiety And Depression Scale. Health and quality of life outcomes, 1, 
29. https://doi.org/10.1186/1477-7525-1-29  
Tinetti, M. E., Richman, D., & Powell, L. (1990). Falls Efficacy as a Measure of Fear of Falling. 
Journal of Gerontology, 45(6), P239-P243. https://doi.org/10.1093/geronj/45.6.P239  
Tomlinson, C. L., Stowe, R., Patel, S., Rick, C., Gray, R., & Clarke, C. E. (2010). Systematic review 
of levodopa dose equivalency reporting in Parkinson's disease. Mov Disord, 25(15), 2649-
2653. https://doi.org/10.1002/mds.23429  
Wu, T., Hallett, M., & Chan, P. (2015). Motor automaticity in Parkinson's disease. Neurobiol Dis, 82, 
226-234. https://doi.org/10.1016/j.nbd.2015.06.014  
Appendices  
• 
Clinical assessment questionnaires/ tests  
o 
Health Questionnaire (PD) 
o 
GENESIS PRAXY Gender Questionnaire (EN/FR) 
o 
Edinburgh Handedness Inventory (EN/FR) 
o 
Waterloo Footedness Questionnaire  
o 
MDS-UPDRS-part Ⅲ 
o 
Hoen and Yahr scale  
o 
NFOGQ 
o 
MOCA  
o 
HADS  
o 
FES 
o 
10MWT 
• 
English and French consent forms  
• 
Permission to contact (EN/FR)