The Effects of fNIRS-based Neurofeedback Training on Balance and Gait in Parkinson's Disease
- Conditions
- Movement Disorder, FunctionalParkinson Disease
- Interventions
- Other: fNIRS-based neurofeedback with motor imageryOther: Kinesthetic motor imagery
- Registration Number
- NCT05800470
- Lead Sponsor
- National Yang Ming Chiao Tung University
- Brief Summary
A cross-sectional study (part 1) aims to investigate the influence of fatigue on the MI ability in PD compared to healthy controls. A randomized controlled trial (part 2) aims to compare the effect of fNIRS-based NFB-MI on balance and gait performance versus MI only in people with PD.
- Detailed Description
To fulfill out study purposes, a cross-sectional study (Part I) and an interventional randomized controlled trial (Part II) are designed. In Part I, people with PD and the age-matched healthy controls will be recruited and perform imagery and actual walking tasks. The level of general fatigue will be measured by Traditional Chinese version of Multidimensional Fatigue Inventory (MFI-TC) in people with PD. The level of concurrent fatigue will be induced by 30-minute cognitive tasks consisting of A-X continuous performance test, 2 back and mental rotation test and will be assessed by Brunel Mood Scale (BRUMS-C) in people with PD. Independent t test will be used to compare the MI ability between PD group and healthy control group. The Pearson's correlation coefficient will be used to examine the relationships between general fatigue level (MFI) and MI ability and between concurrent fatigue level (BRUMS) and MI ability in people with PD. In Part II, people with PD will be randomly allocated to either NFB-MI or MI group. Every participant will receive 12 sessions including three lab-visit sessions and nine home-bases training sessions. Each session consists of 10 min of MI, followed by 20 min of exercise focusing on balance and gait ability. During the lab-visit sessions, participants in experimental group will receive 10 minutes of NFB-MI. Outcome measures, including Mini Balance Evaluation Systems Test (Mini-BEST), Timed up-and-go test (TUG), gait performance, MI ability and fatigue, will be assessed at pre-, post-test, and follow-up. A two-way analysis of variance (ANOVA) with repeated measure will be used to determine the time by group interaction for all the outcomes. Post hoc test with Bonferroni correction will be applied for significant interaction. Significant level for part I and part II will be set at p \< 0.05.
Recruitment & Eligibility
- Status
- NOT_YET_RECRUITING
- Sex
- All
- Target Recruitment
- 48
- aged 40-85 y/o;
- diagnosis of idiopathic PD by neurologist with Hoehn and Yahr stage < 4;
- stable medical condition;
- capability of walking independently for 10 minutes, which is the time needed for imagery walking training in order to eliminate the possible influence of physical fatigue.
- cognitive impairment indicated by MMSE score < 24;
- history of diseases or conditions known to interfere with participating this study (e.g. epilepsy, metal implants in the brain, or deep brain stimulation);
- diagnosis of any other neurological disease or psychiatric disorder (e.g. stroke, anxiety disorder, or depression);
- using central nervous system medications other than for PD, e.g. antiepileptic drugs in recent 3 months.
- obtaining the Handbook of Disabilities verified by the government of local cities in Taiwan.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Neurofeedback combined with MI (NFB-MI) fNIRS-based neurofeedback with motor imagery Participants in both NFB-MI and MI groups will receive a total of 12 sessions of training in 3 weeks. At the first, 4th and 8th session, NFB-MI group will receive fNIRS-based neurofeedback during MI training in lab setting. Prior to each NFB-MI session during lab visit, participants will watch a video of a person executing balance tasks and walking in different environments. The explicit instruction will be given by the researcher. One trial of MI training consists of 30 seconds of imagery tasks and 20 seconds of rest, and the trial will be repeated 12 times. The training will take approximately 10 minutes. Visual feedback with a thermometer based on the changes of HbO concentration will be displayed on the screen during NFB-MI training. In each training session, actual balance and gait tasks will be practiced for 20 min. The difficulty of the tasks will be modified individually for each participant. Motor imagery Kinesthetic motor imagery Participants in both NFB-MI and MI groups will receive a total of 12 sessions of training in 3 weeks. At the first, 4th and 8th session, MI group will practice kinesthetic MI under supervision in lab setting. Prior to each NFB-MI session during lab visit, participants will watch a video of a person executing balance tasks and walking in different environments. The explicit instruction will be given by the researcher. One trial of MI training consists of 30 seconds of imagery tasks and 20 seconds of rest, and the trial will be repeated 12 times. The training will take approximately 10 minutes. In each training session, actual balance and gait tasks will be practiced for 20 min. The difficulty of the tasks will be modified individually for each participant. The researcher will ensure the safety of executing each task during lab visit. Participants will be asked to practice at home and be checked by the daily phone call.
- Primary Outcome Measures
Name Time Method Kinesthetic and visual imagery ability Part 1 cross-sectional assessment (day 1 of the study and day 8 for second assessment) Kinesthetic and visual imagery questionnaire-short version (KVIQ-10) will be used to assess kinesthetic and visual imagery ability. 5 movement will be demonstrated by the assessor and mimicked by the participant. The participant will be asked to visually and kinesthetically imagine the movement without doing the movement. The clarity of the image (visual subscale) and the intensity of the sensations (kinesthetic subscale) will be scored on a five point ordinal scale. The total scores ranged from 10 to 50, and higher scores indicate better ability on kinesthetic and visual imagery.
Change of gait performance from pre-test to follow-up Part 2 pre-test (in the week before the intervention starts) and 4-week follow-up assessment (7 weeks) The gait parameters will be measured by a GAITRite system (CIR system, Inc., Havertown, Pennsylvania). The GAITRite system is a 4.57 m long, 0.9 m wide straight walkway containing pressure-sensitive sensors in a 3.66 m by 0.61 m area. The participants will be instructed to walk along the walkway at their comfortable speed for 3 times. The values at pre-test subtracting from the values at follow-up will be presented.
Self-perceived fatigue for general fatigue level Part 1 cross-sectional assessment (day 1 of the study) Traditional Chinese version of Multidimensional Fatigue Inventory (MFI-TC) will be used to measure subjective perception of fatigue. MFI-TC is a 20-item self-report scale evaluating different dimensions of fatigue (general fatigue/physical fatigue, reduced activity, reduced motivation and mental fatigue). Each item is scored on a 1 (strongly agree) to 5 (strongly disagree) scale to assess how well the statement describe the participant's experience of fatigue. Ten positively phrased items (item 2, 5, 9, 10, 13, 14, 16, 17, 18, 19) were reverse-scored before adding up scores. The total score obtained simply by adding 20-item scores together (i.e., 20-100), with higher scores indicating more fatigue.
Motor imagery ability Part 1 cross-sectional assessment (day 1 of the study and day 8 for second assessment) The walking tasks during motor imagery: walkways of 5 m in length, and 35 cm in width. Participants will be asked to stand upright at the starting line, and then perform imagery walking (IW) and actual walking (AW) task in a total of 2 sessions in the following sequence: IW- walkway (35cm), and AW- walkway. Each session contains three repeated trials of walking over 5 m walkways. The MI ability will be indicated by the index of performance (IP) calculated by \[(AW - IW/ AW) \* 100\]. IP closer to zero indicates better MI ability.
Change of Mini Balance Evaluation Systems Test (Mini-BEST) from pre-test to post-test Part 2 pre-test (in the week before the intervention starts) and post-test (3 weeks) Mini-BEST is used to measure dynamic balance ability in four domains: anticipatory postural adjustment, reactive postural adjustments, sensory integration and dynamic gait. Mini-BEST consists of 14 items scored on a 0-2 scale, with 2 items assess right and left sides. The total scores will be 0-32, and higher scores indicate better balance ability. The scores at pre-test subtracting from the scores at post-test will be presented.
Self-perceived fatigue for concurrent fatigue level Part 1 cross-sectional assessment (day 8 of the study) Chinese version of the Brunel Mood Scale (BRUMS-C) will be used to measure subjective perception of fatigue. Fatigue is a subscale of BRUMS-C consisted with 4-item. Participants indicated whether they have felt on a five-point Likert scale (0 = not at all,1 = a little, 2 = moderately, 3 = quite a bit, 4 = extremely) using the "How do you feel right now?" response timeframe. The total score obtained simply by adding 4-item scores together (i.e., 0-16), with higher scores indicating more fatigue.
Change of Mini Balance Evaluation Systems Test (Mini-BEST) from pre-test to follow-up Part 2 pre-test (in the week before the intervention starts) and 4-week follow-up assessment (7 weeks) Mini-BEST is used to measure dynamic balance ability in four domains: anticipatory postural adjustment, reactive postural adjustments, sensory integration and dynamic gait. Mini-BEST consists of 14 items scored on a 0-2 scale, with 2 items assess right and left sides. The total scores will be 0-32, and higher scores indicate better balance ability.The scores at pre-test subtracting from the scores at follow-up will be presented.
Change of Timed up-and-go test (TUG) from pre-test to follow-up Part 2 pre-test (in the week before the intervention starts) and 4-week follow-up assessment (7 weeks) Functional mobility will be indicated by TUG. Participants will be asked to stand up from a chair, walk at comfortable speed for 3 m, turn around and sit back on the chair. The completing duration will be measured, and the mean value across 3 trials of TUG will be documented as the final performance. The shorter completing duration indicates better mobility function. The duration at pre-test subtracting from the duration at follow-up will be presented.
Change of gait performance from pre-test to post-test Part 2 pre-test (in the week before the intervention starts) and post-test (3 weeks) The gait parameters will be measured by a GAITRite system (CIR system, Inc., Havertown, Pennsylvania). The GAITRite system is a 4.57 m long, 0.9 m wide straight walkway containing pressure-sensitive sensors in a 3.66 m by 0.61 m area. The participants will be instructed to walk along the walkway at their comfortable speed for 3 times. The values at pre-test subtracting from the values at post-test will be presented.
Change of Timed up-and-go test (TUG) from pre-test to post-test Part 2 pre-test (in the week before the intervention starts) and post-test (3 weeks) Functional mobility will be indicated by TUG. Participants will be asked to stand up from a chair, walk at comfortable speed for 3 m, turn around and sit back on the chair. The completing duration will be measured, and the mean value across 3 trials of TUG will be documented as the final performance. The shorter completing duration indicates better mobility function. The duration at pre-test subtracting from the duration at post-test will be presented.
- Secondary Outcome Measures
Name Time Method Change of self-perceived fatigue from pre-test to follow-up Part 2 pre-test (in the week before the intervention starts) and 4-week follow-up assessment (7 weeks) Traditional Chinese version of Multidimensional Fatigue Inventory (MFI-TC) will be used to measure subjective perception of fatigue. MFI-TC is a 20-item self-report scale evaluating different dimensions of fatigue (general fatigue/physical fatigue, reduced activity, reduced motivation and mental fatigue). Each item is scored on a 1 (strongly agree) to 5 (strongly disagree) scale to assess how well the statement describe the participant's experience of fatigue. Ten positively phrased items (item 2, 5, 9, 10, 13, 14, 16, 17, 18, 19) were reverse-scored before adding up scores. The total score obtained simply by adding 20-item scores together (i.e., 20-100), with higher scores indicating more fatigue. The scores at pre-test subtracting from the scores at follow-up will be presented.
Change of motor imagery ability from pre-test to post-test Part 2 pre-test (in the week before the intervention starts) and post-test (3 weeks) There are two conditions for walking tasks during motor imagery: wide and narrow walkways of 15 m in length, and respectively 2 m and 35 cm in width. participants will be asked to stand upright at the starting line, and then perform imagery walking (IW) and actual walking (AW) task in a total of four sessions in the following sequence: IW-wide walkway (2m), AW-wide walkway, IW-narrow walkway (35cm), and AW-narrow walkway. Each session contains three repeated trials of walking over 15 m wide or narrow walkways. The MI ability will be indicated by the index of performance (IP) calculated by \[(AW - IW/ AW) \* 100\]. IP closer to zero indicates better MI ability. The scores at pre-test subtracting from the scores at post-test will be presented.
Change of self-perceived fatigue from pre-test to post-test Part 2 pre-test (in the week before the intervention starts) and post-test (3 weeks) Traditional Chinese version of Multidimensional Fatigue Inventory (MFI-TC) will be used to measure subjective perception of fatigue. MFI-TC is a 20-item self-report scale evaluating different dimensions of fatigue (general fatigue/physical fatigue, reduced activity, reduced motivation and mental fatigue). Each item is scored on a 1 (strongly agree) to 5 (strongly disagree) scale to assess how well the statement describe the participant's experience of fatigue. Ten positively phrased items (item 2, 5, 9, 10, 13, 14, 16, 17, 18, 19) were reverse-scored before adding up scores. The total score obtained simply by adding 20-item scores together (i.e., 20-100), with higher scores indicating more fatigue. The scores at pre-test subtracting from the scores at post-test will be presented.
Change of kinesthetic and visual imagery ability from pre-test to follow-up Part 2 pre-test (in the week before the intervention starts) and 4-week follow-up assessment (7 weeks) Kinesthetic and visual imagery questionnaire-short version (KVIQ-10) will be used to assess kinesthetic and visual imagery ability. 5 movement will be demonstrated by the assessor and mimicked by the participant. The participant will be asked to visually and kinesthetically imagine the movement without doing the movement. The clarity of the image (visual subscale) and the intensity of the sensations (kinesthetic subscale) will be scored on a five point ordinal scale. The total scores ranged from 10 to 50, and higher scores indicate better ability on kinesthetic and visual imagery. The scores at pre-test subtracting from the scores at follow-up will be presented.
Change of motor imagery ability from pre-test to follow-up Part 2 pre-test (in the week before the intervention starts) and 4-week follow-up assessment (7 weeks) There are two conditions for walking tasks during motor imagery: wide and narrow walkways of 15 m in length, and respectively 2 m and 35 cm in width. participants will be asked to stand upright at the starting line, and then perform imagery walking (IW) and actual walking (AW) task in a total of four sessions in the following sequence: IW-wide walkway (2m), AW-wide walkway, IW-narrow walkway (35cm), and AW-narrow walkway. Each session contains three repeated trials of walking over 15 m wide or narrow walkways. The MI ability will be indicated by the index of performance (IP) calculated by \[(AW - IW/ AW) \* 100\]. IP closer to zero indicates better MI ability. The scores at pre-test subtracting from the scores at follow-up will be presented.
Change of kinesthetic and visual imagery ability from pre-test to post-test Part 2 pre-test (in the week before the intervention starts) and post-test (3 weeks) Kinesthetic and visual imagery questionnaire-short version (KVIQ-10) will be used to assess kinesthetic and visual imagery ability. 5 movement will be demonstrated by the assessor and mimicked by the participant. The participant will be asked to visually and kinesthetically imagine the movement without doing the movement. The clarity of the image (visual subscale) and the intensity of the sensations (kinesthetic subscale) will be scored on a five point ordinal scale. The total scores ranged from 10 to 50, and higher scores indicate better ability on kinesthetic and visual imagery. The scores at pre-test subtracting from the scores at post-test will be presented.