The Learning Effects of Attentional Strategy on Dual-task Walking in Patients With Parkinson's Disease: Behavioral Performance and Neural Plasticity

Study Overview
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Brief Summary
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[year1] To compare the effects of dual-task training with two different task priority instruction in people with Parkinson's disease and healthy controls on dual-task weight shifting performances. Investigate the changes of brain activities and functional connectivity after dual-task training with different task priority instructions. [year 2-3] To investigate the learning effects of walking with internal/external focus on walking automaticity and brain plasticity in dual-task walking training for PD patients with/without freezing of gait.

Detailed Description
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Postural-suprapostural task is defined as postural control takes place while another concurrent task is being performed, belonging to dual-task paradigms. Effective dual-task training is important to patients with Parkinson disease (PD), because they often lose balance and fall in dual-task conditions. Attentional strategy includes 1) task-priority between postural and suprapostural tasks and 2) internal and external focus for the postural task, which is the critical factor for both dual-task control and motor learning. However, the appropriateness of attentional strategy has not been investigated in dual-task training in patients with PD. Besides, there is lack of neural evidence of brain plasticity for previous studies about dual-task training in patients with PD. With the uses of EEG, EMG and behavioral measures, the purpose of this 3-year research project is to investigate the differences in performance quality and intrinsic neural mechanisms of dual-task training in PD, by adopting task-priority strategy and internal/external strategy during weight-shifting and walking. In the first year, the investigators will characterize task-priority effect (posture-priority vs. supraposture-priority) on dual-task training, with a special focus on modulation of brain plasticity and muscle activity patterns in weight-shifting posture for patients with PD. In the second and third years, the learning effects of walking internal/external focus on walking automaticity and brain plasticity will be investigated in dual-task walking training for PD patients with/without freezing of gait. Besides, the transfer effects of dual-task learning will be also investigated on medication off state. The present project is expected to have significant contributions not only to gain a better insight to neural correlates of dual-task training with different attentional strategies under weight-shifting and walking, but to optimize treatment strategy for PD patients with balance or dual-tasking disturbances.

Official Title
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The Learning Effects of Attentional Strategy on Dual-task Walking in Patients With Parkinson's Disease: Behavioral Performance and Neural Plasticity

Conditions
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Parkinson Disease

Intervention / Treatment
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* Behavioral: [year1] dual-task training with task priority strategy
* Behavioral: [year2-3] dual-task training with internal and external focus


Participation Criteria
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Eligibility Criteria
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[year1] Inclusion criteria: For people with Parkinson's disease modified Hoehn & Yahr stage 2-3 without dementia and able to follow instructions For healthy controls age and gender matched healthy subjects as control group Exclusion criteria: MMSE < 26 with other disease that may influence balance ability with marked action and postural tremor [year2-3] inclusion criteria: idiopathic Parkinson's disease modified Hoehn & Yahr stage 2-3 without marked action or postural tremor exclusion criteria: MMSE < 26 with other disease that may influence balance ability

Ages Eligible for Study
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Minimum Age: 40 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: [year1] PD group<br> | Behavioral: [year1] dual-task training with task priority strategy<br>* postural focus: focus mainly on postural performances while dual-tasking suprapostural focus: focus mainly on suprapostural performances while dual-tasking<br>|
| Active Comparator: [year1] healthy control group<br> | Behavioral: [year1] dual-task training with task priority strategy<br>* postural focus: focus mainly on postural performances while dual-tasking suprapostural focus: focus mainly on suprapostural performances while dual-tasking<br>|
| Experimental: [year2-3] freezer<br> | Behavioral: [year2-3] dual-task training with internal and external focus<br>* internal focus: focus mainly on body movements external focus: focus mainly on object in the environment<br>|
| Experimental: [year2-3] non-freezer<br> | Behavioral: [year2-3] dual-task training with internal and external focus<br>* internal focus: focus mainly on body movements external focus: focus mainly on object in the environment<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| postural performance | measuring the amount of body weight shifting (unit: kg) | about 36 seconds for each trial for a total of 25 minutes | 
| suprapostural performance | measuring the rotation angle of box on the hand (unit: degree) | about 36 seconds for each trial for a total of 25 minutes | 
| Walking speed | collecting by using the GAITRite electronic walkway (CIR systems, Inc. ,USA) 24 inches(61cm) wide and 192 inches (488cm, 16ft) long, total 18,432 sensor (unit: m/s) | about 10-20 seconds for each trial | 
| Cadence | collecting by using the GAITRite (unit: step/s) | about 10-20 seconds for each trial | 
| Gait symmetry | collecting single leg supporting time of right and left leg by using the GAITRite | about 10-20 seconds for each trial | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| electroencephalography (EEG) | to collect the brain activity (unit: uV) | about 36 seconds for each trial for a total of 25 minutes | 
| electromyography (EMG) | to collect the muscle activity (unit: mV) | about 36 seconds for each trial for a total of 25 minutes | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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dual-task training, attention, Parkinson's disease, walking, EEG