The Impact of Standard Medical Care (Dopamine) and Practice on Postural Motor Learning in Parkinson's Disease



Status:Completed
Conditions:Parkinsons Disease
Therapuetic Areas:Neurology
Healthy:No
Age Range:50 - 80
Updated:2/23/2018
Start Date:July 2016
End Date:May 11, 2017

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The study determines whether standard medical care (dopamine) affects learning and retention
of a postural stepping task in people with Parkinson's disease (PD) and whether training on a
postural stepping task generalises to performance on an untrained postural task. Half the
participants will train on the stepping task after they have taken their first dose of
dopamine for the day (i.e. "on" medication state) while the other half will train on the same
stepping task before taking their first daily dose of dopamine (i.e. "off" medication state).

Motor learning is critical for acquiring new skills and adapting behaviour, therefore the
success of rehabilitation depends on successful motor learning through practice. Motor
learning involves the basal ganglia, including both the associative and sensorimotor
striatum. Although people with PD are capable of motor learning, they are less efficient and
do not achieve the same extent of skill acquisition and retention as people without
neurological deficit.

Reductions in endogenous dopamine and reduced dopamine binding associated with loss of
dopaminergic receptors due to disease progression may impair motor learning in people with
PD. Conflicting evidence suggests that impaired motor learning in PD is due on the one hand
to the absence of dopamine but on the other hand to "overdosing" of the basal ganglia with
dopamine replacement therapy which suppresses activation of the associative striatum during
the early acquisition stages of motor learning.

Understanding which factors improve or degrade motor learning of tasks will allow
rehabilitation parameters to be adjusted around standard medical care in order to optimize
learning and improve the efficacy of exercise interventions for people with PD. In
particular, successful learning of postural tasks that challenge stability may in turn reduce
falls.

Inclusion Criteria:

- Idiopathic Parkinson's disease confirmed by neurologist

- Hoehn and Yahr stages 1 to 3

- On a stable dose of antiparkinsonian medication for the past month and will continue
on this regime for at least another subsequent month

- Walks unaided

Exclusion Criteria:

- Not taking dopamine replacement therapy

- With prior surgical management for PD (e.g. deep brain stimulation)

- With medication-resistant freezing of gait

- Significant cognitive impairment (Montreal Cognitive Assessment score <18)

- Unstable medical conditions

- Other neurological conditions

- Unable to follow instructions or safely complete the training tasks
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Salt Lake City, Utah 84108
801) 581-7200
Phone: 801-587-3181
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