Motor Adaptation to Split-Belt Treadmill in Parkinson's Disease

Study Overview
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Brief Summary
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Freezing of Gait (FOG) is a disabling symptom common in advanced Parkinson's Disease. FOG is an independent contributor to fall risk and is only partially relieved by medication. Parkinson's patients with FOG are known to have more difficulty with gait adaptation in their day to day environment. Further, asymmetry of gait has been implicated in FOG as these episodes are often elicited during asymmetric tasks such as turning. This study will examine the effect of a single session of split-belt treadmill walking on gait adaptation, gait symmetry and FOG as well as 24 hour retention of these effects.

Detailed Description
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In this proposal, the investigators will investigate whether adapting gait to modulations imposed by a split-belt treadmill, improves walking ability and reduces FOG. The investigators will test the hypothesis that motor adaptation deficits underlie FOG and that these problems are modifiable with training. To address these suppositions, the investigators propose a multi-centric study conducted in two research labs with expertise in split-belt gait analysis and FOG: University of Leuven (KUL) and Christian-Albrechts-University Kiel (CAUK). As freezers have been shown to have more difficulty with consolidation of motor learning, the investigators aim in study I (pilot phase) to first understand which split-belt parameters are optimal for training gait flexibility and lead to consolidated gains in daily walking. For this study, the investigators will recruit 60 freezers and 60 healthy controls, pooled across centers, and manipulate different split-belt conditions in one learning and retention session.

Official Title
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Influence of Multiple Ratio Split-belt Treadmill on Gait Asymmetry and Motor Learning in PD Patients With Freezing of Gait

Conditions
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Parkinson Disease, Freezing of Gait

Intervention / Treatment
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* Behavioral: Split-Belt Treadmill Training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of Parkinson's Disease as per the UK Parkinson's Disease Society Brain Bank Criteria Classification as a Freezer with the New Freezing of Gait Questionnaire (score > 0) Ability to walk at least 5 min. without any aid Stable anti-parkinsonian medication at least 1 month prior to participation Exclusion Criteria: Neurologic diseases other than PD Orthopedic injuries that could influence gait and balance Participation in treadmill training more than once a week Cognitive impairment (MMSE<24) or inability to follow test instructions Self-reported DBS-related postural or gait disturbances Cardiovascular risk factors Peripheral neuropathy

Ages Eligible for Study
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Minimum Age: 18 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
Interventional Model Description: Participants will randomly be assigned to 1 of 4 different split-belt treadmill paradigms. Assessments will be performed pre and post training on day 1 and once again on day 2.
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Split-Belt Treadmill Training 1:2<br>Split-Belt Training with a steady ratio of 1:2. | Behavioral: Split-Belt Treadmill Training<br>* One session of 6 x 5 min with 1 min intervals.<br>|
| Experimental: Split-Belt Treadmill Training 3:4<br>Split-Belt Training with a steady ratio of 3:4. | Behavioral: Split-Belt Treadmill Training<br>* One session of 6 x 5 min with 1 min intervals.<br>|
| Experimental: Split-Belt Treadmill Training Changing<br>Split-Belt Training with changing ratios between 3:4 to 1:2. | Behavioral: Split-Belt Treadmill Training<br>* One session of 6 x 5 min with 1 min intervals.<br>|
| Active Comparator: Split-Belt Treadmill Training Tied-Belt<br>Split-Belt Training with tied belts. | Behavioral: Split-Belt Treadmill Training<br>* One session of 6 x 5 min with 1 min intervals.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Adaptation to Split/Tied Belt | Measured with 3D motion analysis system during treadmill walking. Patients will walk for 1.5 minutes on the treadmill that will switch from tied-to-split state and back to tied state. | 24 hours after training | 
| Gait Asymmetry | Measured with 3D motion analysis system during straight line overground walking | 24 hours after training | 
| Freezing Ratio | Measured with APDM sensors during 360 degree turns | 24 hours after training | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Medio-lateral Anticipatory Postural Adjustments | Measured with APDM sensors at gait initiation | 24 hours after training | 
| Gait Speed during dual task walking | Measured with 3D motion analysis system during overground walking with an auditory Stroop task | 24 hours after training | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Split-Belt Treadmill, Training