Effects of Rhythmic Auditory Cueing on Stepping in Place in Patients With Parkinson's Disease
Condition: Parkinson Disease
MeSH terms: Parkinson Disease
Study type: Interventional

Summary: 
      Patients with Parkinson's disease have internal rhythm dysfunction, which may affect the
      rhythmic movements such as walking. Poor regularity of the rhythmic movement may lead to
      freezing of gait. This study will apply rhythmic auditory cues on the stepping-in-place
      training and the investigators will examine if the behavior and neuroelectrophysiology would
      change after auditory cueing training. The investigators hypothesize the variation of
      rhythmic movements such as walking and stepping-in-place will be reduced, and the cortical
      excitability would be modulated after training.
    

Detailed description: 
      Parkinson's disease is a common neurodegenerative disease and movement disorder. Due to the
      degeneration of basal ganglia, patients with Parkinson's disease also demonstrate internal
      rhythm dysfunction, thus will lead to difficulty in rhythmic movements such as ambulation.
      For improving the rhythmic movement problem, auditory cues are often used in clinical setting
      and shows benefits in ambulation and freezing problems. Previous studies often use finger
      tapping test and ambulation to assess the rhythmic movement problem. No study uses stepping
      in place movements as a test to examine rhythmic problem. Little study investigates the
      effects of auditory cues on brain cortical excitability. In this cross-over study,
      participants will receive 2 times of training include stepping-in-place exercise with and
      without auditory cues in random orders. Auditory cues are given via the metronome. There is
      one-week wash-out period between two trainings. Movement tests such as walking and
      stepping-in-place and transcranial magnetic stimulation (TMS) are carried out before and
      after each training.

      The investigators hypothesize the variation of rhythmic movements such as walking and
      stepping-in-place will be reduced more, and the cortical excitability would be modulated
      after the training with auditory cues, comparing with the other training without auditory
      cues.
    

Intervention name(s): Stepping-in-place exercise with external auditory cues; Transcranial magnetic stimulation (TMS)
Intervention type(s): Behavioral; Device
Intervention description(s): The stepping-in-place exercise includes 10-session training. In each session, subjects are asked for stepping for 50 steps. In auditory cued condition, the cued frequency is set at 110% of the usual walking cadence. While in non-cued condition, we ask the subjects to step according to their own internal rhythm.; TMS is used to assess the cortical excitability of the motor cortex. The stimulation intensity is set at 130% of the motor threshold in single-pulse condition. In paired-pulse condition, the first stimulus is set at 80% of the motor threshold and the second stimulus is set at 130% of the motor threshold.
Other intervention name(s): Stepping-in-place exercise without external auditory cues
Allocation: Non-Randomized
Intervention model: Crossover Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Parkinson's disease; Auditory cues; step in place; transcranial magnetic stimulation; cortical excitability