Gait Initiation Difficulty and Anticipatory Postural Adjustment (APA) Impairment in People With PD - Evaluation and Training

Not Applicable

Completed

• Conditions: Parkinson Disease(PD)
• Interventions: Other: Weight shift training without APA feedback; Other: Weight shift training and APA feedback

• Registration Number: NCT02656355
• Lead Sponsor: Chang Gung University

Brief Summary

Gait initiation (GI) difficulty is common in people with Parkinson's disease (PD). Studies showed that the GI difficulty was related to impaired anticipatory postural adjustments (APA). In healthy people, two phases of APA related center of pressure (COP) shifting were observed before GI. In people with PD, delay and decrease amplitude of APA or abnormal multiple APAs were observed during GI.

Conventional balance tests record the maximum displacement and/or velocity of Center of pressure (COP). However, these variables could not show the performance of APA. Previous studies suggested that balance and gait initiation were controlled by separate neural circuitries. This could explain why the conventional COP measurement did not correlate to GI very well.

It is important to develop GI related APA tests and trainings. Researchers found that a perturbation applied before the COP displacement during GI could delay both GI and APA. This indicates that COP displacement has APA components. Our pilot study shows that there is a reverse direction of COP displacement before voluntary COP displacement, suggesting the existence of APA.

This three year project will evaluate the relationship of the APA of voluntary COP displacement and the APA of GI, establish the APA test for PD, and investigate the effect of APA training on GI in people with PD.

In the first year, 20 people without disability will be recruited. The APA before voluntary COP displacement test, APA before GI, and gait performance will be evaluated. In the second year, 15 people with PD and 15 healthy people will be recruited. Subjects will receive GI test, gait test, and APA before voluntary COP displacement test. The relationship between different types of APA will be established for PD and healthy people. In the third year, 30 people with PD will be randomized into APA training group, balance group, and control group. The different training effect will be evaluated especially on GI, gait performance, and freezing of gait.

This project will advance the knowledge of mechanism of GI difficulty. The result of this project can be applied to clinical rehabilitation of people with GI difficulty.

Detailed Description

Not available

Study Timeline

• Study Start: 2015-05-11
• Study First Submitted: 2016-01-13
• Study First Submitted QC: 2016-01-13
• Study First Posted: 2016-01-14
• Primary Completion: 2018-10-30
• Study Completion: 2019-01-31
• Status Verified: 2024-03
• Last Update Submitted: 2024-03-26
• Last Update Posted: 2024-03-27

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 55

Inclusion Criteria

• Clinical diagnosis of Parkinson disease.

Exclusion Criteria

• Musculoskeletal injuries on legs
• Osteoporosis.
• Any peripheral or central nervous system injury or disease patients.

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Stage 3:PD Balance training group	Weight shift training without APA feedback	Weight shift training without APA feedback.
Stage 3:PD APA training group	Weight shift training and APA feedback	Weight shift training and APA feedback.

Primary Outcome Measures

Name	Time	Method
Balance parameters	Baseline, 4 weeks and 8 weeks.	Measure of changes in balance parameters by force plate.
Gait parameters	Baseline, 4 weeks and 8 weeks.	Measure of changes in gait parameters by GaitRite and force plate.

Trial Locations

Locations (1)

Chang Gung University; 🇨🇳 Taoyuan, Taiwan