Gait initiation (GI) difficulty is a common problem in individuals with Parkinson's disease (PD), often linked to impaired anticipatory postural adjustments (APA). Currently, there are no targeted rehabilitation programs designed specifically for GI-related APA in PD patients. Research has shown that while motor learning deficits are common in PD, explicit learning is better preserved than implicit learning. Therefore, a GI-related APA training system using an explicit learning model could be particularly effective for this population. During motor learning, long-term potentiation (LTP) increases the excitability of the primary motor cortex. Paired associative stimulation (PAS) has been demonstrated to induce LTP-like changes in the motor cortex, making it a potential priming method to enhance motor learning. However, the priming effect of PAS targeted at leg muscles and the motor cortex on motor learning related to GI-APA has not been previously studied. The objectives of this study are: 1. To investigate the effects of explicit and implicit training on GI-related APA. 2. To evaluate the priming effect of PAS on GI-related APA training and the associated plasticity changes in the motor cortex.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
60
Use COP trajectory to train weight shift on force plate. To give APA visual feedback for subjects after weight shift training.
Use TMS combine ES to stimulate TA nerve and M1 cortical
Chang Gung University
Taoyuan District, Taiwan
RECRUITINGBalance Performance
Measured by the duration the stance or stand can be maintained. Unit：second(s)
Time frame: Baseline, 4 weeks and 8 weeks
COP Path Length in Balance Tasks
The total distance traveled by the COP over a specified period. Longer path lengths can indicate increased effort to maintain balance or greater instability.
Time frame: Baseline, 4 weeks and 8 weeks
COP Displacement in Balance Tasks
Measures of COP movement in the anterior-posterior (AP) and medial-lateral (ML) directions, offering insights into the directional tendencies of balance control. Unit：millimeter(mm)
Time frame: Baseline, 4 weeks and 8 weeks
Motor Evoked Potentials (MEPs)
MEPs are the electrical responses recorded from muscles following stimulation of the motor cortex. They reflect the efficiency of neural transmission from the cortex to the muscle. Unit：millivolts (mV)
Time frame: Baseline, 4 weeks and 8 weeks
Intracortical Facilitation (ICF)
ICF is measured by applying a pair of TMS pulses with a short interval (e.g., 8-15 ms) where the first (subthreshold) pulse is followed by a second (suprathreshold) pulse, leading to an increased amplitude of the MEP.
Time frame: Baseline, 4 weeks and 8 weeks
Intracortical Inhibition (ICI)
ICI is measured similarly to ICF but with a shorter inter-stimulus interval (e.g., 1-5 ms), resulting in a suppressed MEP amplitude. This suppression reflects inhibitory processes within the cortex.
Time frame: Baseline, 4 weeks and 8 weeks
Walking Speed
The time taken by participants to walk a standardized distance, typically expressed in centimeters per second (cm/s).
Time frame: Baseline, 4 weeks and 8 weeks
Step Length
The linear distance between the two ankles, typically expressed in centimeter(cm).
Time frame: Baseline, 4 weeks and 8 weeks
Step Time
The duration taken for one complete step, measuring from foot-off of one foot to the next foot-off of the same foot, usually expressed in seconds.
Time frame: Baseline, 4 weeks and 8 weeks
COP Velocity in Balance Tasks
The speed at which the COP moves, calculated over the duration of the balance task. Higher velocities may reflect more dynamic balance adjustments or instability. Unit：millimeter per second(mm/s)
Time frame: Baseline, 4 weeks and 8 weeks
COP Area in Balance Tasks
The area covered by the COP trajectory during the balance task, providing an estimate of the sway envelope. A larger area might indicate poorer balance control. Unit：square millimeter(mm\^2)
Time frame: Baseline, 4 weeks and 8 weeks
Double Support Time
The portion of the gait cycle where both feet are in contact with the ground, indicating the transition phase between steps, expressed as a percentage of the gait cycle or in seconds.
Time frame: Baseline, 4 weeks and 8 weeks
Single Support Time
The duration within the gait cycle when only one foot is in contact with the ground, typically measured in seconds or as a percentage of the total gait cycle.
Time frame: Baseline, 4 weeks and 8 weeks
Swing Time
The portion of the gait cycle where the foot is not in contact with the ground, moving forward to the next step. It is usually expressed as a percentage of the total gait cycle or in seconds.
Time frame: Baseline, 4 weeks and 8 weeks
Stance Time
The portion of the gait cycle when the foot is in contact with the ground, supporting body weight. It's typically expressed as a percentage of the total gait cycle or in seconds
Time frame: Baseline, 4 weeks and 8 weeks
Cadence
The number of steps an individual takes per minute, providing an overview of gait speed and rhythm, , expressed as steps per minute.
Time frame: Baseline, 4 weeks and 8 weeks
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