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Motor learning in people with Parkinson’s disease: Implications for fall prevention across the disease spectrum

Published on Jan 1, 2018in Gait & Posture2.414
· DOI :10.1016/j.gaitpost.2018.01.026
Serene S. Paul16
Estimated H-index: 16
(USYD: University of Sydney),
Leland E. Dibble27
Estimated H-index: 27
(UofU: University of Utah),
Daniel S. Peterson14
Estimated H-index: 14
(ASU: Arizona State University)
Abstract
Abstract Background Falls are a significant burden for people with Parkinson’s disease (PD), however, individuals across the spectrum of disease severity respond differently to fall prevention interventions. Despite the multifactorial causes of falls in people with PD, recent work has provided insight into interventions that hold promise for fall prevention. Further, studies have begun to identify patient characteristics that may predict responsiveness to such interventions. Research question We discuss (i) the postural motor learning abilities of people with mild versus severe PD that could affect their ability to benefit from fall prevention interventions, (ii) how people with different severity of PD respond to such interventions, and (iii) the practical considerations of providing effective fall prevention interventions for people with PD across the spectrum of disease severity. Methods This narrative review consolidates recent work on postural motor learning and fall prevention rehabilitation involving exercise in people with PD. Results People with PD are able to improve postural motor control through practice, enabling them to benefit from exercise which challenges their gait and balance to reduce falling. Worsening of axial and cognitive symptoms may result in diminished learning, and those with more severe PD may require fully supervised, high intensity programs to reduce falls. Significance Understanding how people with PD across the spectrum of disease severity differ in their postural motor learning ability and response to different fall prevention interventions will enable researchers and clinicians to refine such interventions and their delivery to minimize falls and their negative sequelae in people with PD.
  • References (52)
  • Citations (8)
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References52
Newest
#1Catherine Sherrington (The George Institute for Global Health)H-Index: 55
#2Zoe A. Michaleff (Arthritis Research UK)H-Index: 11
Last. Stephen R. Lord (UNSW: University of New South Wales)H-Index: 94
view all 10 authors...
Objective Previous meta-analyses have found that exercise prevents falls in older people. This study aimed to test whether this effect is still present when new trials are added, and it explores whether characteristics of the trial design, sample or intervention are associated with greater fall prevention effects. Design Update of a systematic review with random effects meta-analysis and meta-regression. Data sources Cochrane Library, CINAHL, MEDLINE, EMBASE, PubMed, PEDro and SafetyLit were sea...
160 CitationsSource
#1Karen Van Ooteghem (UW: University of Waterloo)H-Index: 5
#2James S. Frank (UW: University of Waterloo)H-Index: 32
Last. Fay B. Horak (OHSU: Oregon Health & Science University)H-Index: 82
view all 3 authors...
Abstract Introduction Although balance training is considered the most effective treatment for balance impairments in Parkinson’s disease (PD), few studies have examined if learning for balance control remains intact with PD. This study aimed to determine if learning for automatic postural responses is preserved in people with PD. Methods Eleven participants with moderate PD (68 ± 6.4 years; H&Y: 2–3) on their usual medication maintained balance on a platform that oscillated forward and backward...
3 CitationsSource
#1Lucio MarinelliH-Index: 20
#2Angelo Quartarone (UNIME: University of Messina)H-Index: 2
Last. Maria Felice Ghilardi (CUNY: City University of New York)H-Index: 40
view all 5 authors...
Abstract The final goal of motor learning, a complex process that includes both implicit and explicit (or declarative) components, is the optimization and automatization of motor skills. Motor learning involves different neural networks and neurotransmitters systems depending on the type of task and on the stage of learning. After the first phase of acquisition, a motor skill goes through consolidation (i.e., becoming resistant to interference) and retention, processes in which sleep and long-te...
23 CitationsSource
#1Robyn Lamont (UQ: University of Queensland)H-Index: 5
#2Meg E. Morris (La Trobe University)H-Index: 62
Last. Sandra G. Brauer (UQ: University of Queensland)H-Index: 37
view all 5 authors...
Abstract Background Falls are common and debilitating in people with Parkinson’s disease (PD) and restrict participation in daily activities. Understanding circumstances of falls in the community and at home may assist clinicians to target therapy more effectively. Objective To compare the characteristics of community and home fallers and the circumstances that contribute to falls in people living with PD. Methods People with mild-moderately severe PD (n = 196) used a daily falls diary and telep...
16 CitationsSource
#1Sydney Y. Schaefer (ASU: Arizona State University)H-Index: 13
#2Kevin Duff (UofU: University of Utah)H-Index: 38
ABSTRACTPractice effects on neuropsychological tests, which are improvements in test scores due to repeated exposure to testing materials, are robust in healthy elders, but muted in older adults with cognitive disorders. Conversely, few studies have investigated practice effects on motor tasks involving procedural memory, particularly across test–retest periods exceeding 24 hours. The current study examined one-week practice effects on a novel upper extremity motor task in 54 older adults with a...
7 CitationsSource
#1Meg E. Morris (La Trobe University)H-Index: 62
#2Nicholas F. Taylor (La Trobe University)H-Index: 49
Last. Hylton B. Menz (La Trobe University)H-Index: 66
view all 10 authors...
Abstract Questions For people with idiopathic Parkinson's disease, does a 6-week, comprehensive, home exercise program reduce falls and disability and improve health-related quality of life? Is the program cost-effective? Design Randomised, controlled trial with concealed allocation and assessor blinding. Participants One hundred and thirty-three community-dwelling adults with Parkinson's disease. Intervention The experimental group completed a 6-week home program comprising progressive resistan...
12 CitationsSource
#1Dag AarslandH-Index: 92
#2Byron Creese (Wolfson Centre for Age-Related Diseases)H-Index: 8
Last. Clive BallardH-Index: 97
view all 7 authors...
Dementia is commonly encountered in advanced stages of Parkinson disease (PD), but evidence is accumulating that cognitive decline can manifest much earlier in the disease course. Aarsland and colleagues review current knowledge regarding cognitive impairment in patients with PD, focusing on cerebrospinal fluid and imaging biomarkers as potential predictors of cognitive decline in this population.
150 CitationsSource
#1Sue Lord (Newcastle University)H-Index: 32
#2Brook Galna (Newcastle University)H-Index: 26
Last. Lynn Rochester (Newcastle University)H-Index: 53
view all 6 authors...
Background Falls are common and associated with reduced independence and mortality in Parkinson's disease. Previous research has been conducted on falls-prevalent or advanced disease cohorts. Objective This study identifies risk factors for first fall for 36 months in a newly diagnosed, falls-naive cohort. Methods A total of 121 consecutive Parkinson's disease patients were recruited. Falls data were collected prospectively during 36 months from diagnosis via monthly falls diaries and telephone ...
34 CitationsSource
#1Daniel S. Peterson (ASU: Arizona State University)H-Index: 14
#2Fay B. Horak (OHSU: Oregon Health & Science University)H-Index: 82
Abstract Protective postural responses, including stepping, to recover equilibrium are critical for fall prevention and are impaired in people with Parkinson’s disease (PD) with freezing of gait (FoG). Improving protective postural responses through training may reduce falls in this population. However, motor learning, the basis of neurorehabilitation, is also impaired in people with PD and, in particular, people with PD who experience freezing. It is unknown whether people with PD who freeze ca...
12 CitationsSource
#1Anat Mirelman (TAU: Tel Aviv University)H-Index: 32
#2Lynn Rochester (Newcastle University)H-Index: 53
Last. Jeffrey M. Hausdorff (TAU: Tel Aviv University)H-Index: 87
view all 16 authors...
Summary Background Age-associated motor and cognitive deficits increase the risk of falls, a major cause of morbidity and mortality. Because of the significant ramifications of falls, many interventions have been proposed, but few have aimed to prevent falls via an integrated approach targeting both motor and cognitive function. We aimed to test the hypothesis that an intervention combining treadmill training with non-immersive virtual reality (VR) to target both cognitive aspects of safe ambula...
89 CitationsSource
Cited By8
Newest
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#1Louise M. Carroll (UL: University of Limerick)H-Index: 1
#2Meg E. Morris (La Trobe University)H-Index: 62
Last. Amanda M. Clifford (UL: University of Limerick)H-Index: 10
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BACKGROUND: Aquatic therapy offers an alternative physiotherapy approach to managing the motor and non-motor symptoms associated with Parkinson's disease (PD). OBJECTIVE: This review examined exercise prescription for aquatic therapy in PD and evaluated if aquatic therapy is as effective as land-based physiotherapy for improving movement, disability and wellbeing in people living with PD. METHODS: A systematic search of eight databases was conducted to identify suitable randomized controlled tri...
Source
#1T. T. C. Capato (USP: University of São Paulo)H-Index: 1
#2Nienke M. de Vries (Radboud University Nijmegen)H-Index: 8
Last. Bastiaan R. Bloem (Radboud University Nijmegen)H-Index: 78
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Background: Balance impairment in Parkinson’s disease (PD) improves only partially with dopaminergic medication. Therefore, non-pharmacological interventions such as physiotherapy are important elements in clinical management. External cues are often applied to improve gait, but their effects on balance control are unclear.
1 CitationsSource
#1Nathaniel T. Pickle (UTD: University of Texas at Dallas)H-Index: 4
#2Staci Shearin (UTSW: University of Texas Southwestern Medical Center)
Last. Nicholas P. Fey (UTD: University of Texas at Dallas)H-Index: 14
view all 3 authors...
Clinical balance assessments often rely on functional tasks as a proxy for balance (e.g., Timed Up and Go). In contrast, analyses of balance in research settings incorporate quantitative biomechanical measurements (e.g., whole-body angular momentum, H) using motion capture techniques. Fully instrumenting patients in the clinic is not feasible, and thus it is desirable to estimate biomechanical quantities related to balance from measurements taken from a subset of the body segments. Machine learn...
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#1Jana Seuthe (CAU: University of Kiel)
#2Nicholas D‘Cruz (Katholieke Universiteit Leuven)
Last. Christian Schlenstedt (CAU: University of Kiel)H-Index: 7
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Abstract Background Walking on a split-belt treadmill (SBT) can help to modulate an asymmetric gait, particularly for people with neurological conditions, such as Parkinson’s disease (PD), where asymmetry plays a role due to the laterality of the disease. Research question This systematic review critically evaluates the literature on SBT in PD. First, different SBT paradigms and methodological approaches were evaluated. Second, the review explored how people with PD adapt their gait to different...
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#1Nicollette L. Purcell (Rush University Medical Center)
#2Jennifer G. Goldman (Rush University Medical Center)H-Index: 29
Last. Joan A. O'Keefe (Rush University Medical Center)H-Index: 9
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Background: Huntington's disease (HD) is characterized by chorea, balance and gait impairments, and cognitive deficits, which increase fall risk. Dual task (DT) and environmentally challenging paradigms reflect balance related to everyday life. Furthermore, the impact of cognitive deficits on balance dysfunction and falls in HD is unknown. Objective: To determine the impact of DT interference, sensory feedback, and cognitive performance on balance and falls in HD. Methods: Seventeen participants...
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#1Markey Olson (ASU: Arizona State University)H-Index: 2
#2Thurmon E. Lockhart (ASU: Arizona State University)H-Index: 24
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Parkinson’s disease (PD) is a neurological disorder traditionally associated with degeneration of the dopaminergic neurons within the substantia nigra, which results in bradykinesia, rigidity, tremor, and postural instability and gait disability (PIGD). The disorder has also been implicated in degradation of motor learning. While individuals with PD are able to learn, certain aspects of learning, especially automatic responses to feedback, are faulty, resulting in a reliance on feedforward syste...
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#1S.I.B. Perry (UvA: University of Amsterdam)
#2P.M. Nelissen (UvA: University of Amsterdam)
Last. C. Lucas (UvA: University of Amsterdam)
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Abstract Objective To evaluate the effect of functional-task training on activities of daily living (ADL) in people with Parkinson`s Disease. Methods We searched five databases (Cinahl, Embase, Medline, Pedro and CENTRAL). The included studies were assessed on therapeutic validity and risk of bias. We classified the quality of evidence according to the principles of the GRADE approach. All assessments were executed independently by two researchers. The results of included studies were pooled in ...
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#1Serene S. Paul (USYD: University of Sydney)H-Index: 16
#2Sydney Y. SchaeferH-Index: 13
Last. Leland E. Dibble (UofU: University of Utah)H-Index: 27
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Introduction. Treatment of Parkinson’s disease (PD) with exogenous dopamine (ie, levodopa) may positively affect motor symptoms, but may negatively affect other functions such as the learning of mo...
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Oct 26, 2018 in EMBC (International Conference of the IEEE Engineering in Medicine and Biology Society)
#1Nathaniel T. Pickle (UTD: University of Texas at Dallas)H-Index: 4
#2Staci Shearin (UTSW: University of Texas Southwestern Medical Center)
Last. Nicholas P. Fey (UTSW: University of Texas Southwestern Medical Center)H-Index: 14
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Clinical Balance Assessments Often Rely On Functional Tasks As A Proxy For Balance (E.G., Timed Up And Go). In Contrast, Analyses Of Balance In Research Settings Incorporate Quantitative Biomechanical Measurements (E.G., Whole-Body Angular Momentum, H) Using Motion Capture Techniques. Fully Instrumenting Patients In The Clinic Is Not Feasible, And Thus It Is Desirable To Estimate Biomechanical Quantities Related To Balance From Measurements Taken From A Subset Of The Body Segments. Machine Learn...
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