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Postural motor learning in people with Parkinson’s disease

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Abstract

Protective postural responses to external perturbations are hypokinetic in people with Parkinson’s disease (PD), and improving these responses may reduce falls. However, the ability of people with PD to improve postural responses with practice is poorly understood. Our objective was to determine whether people with PD can improve protective postural responses similarly to healthy adults through repeated perturbations, and whether improvements are retained or generalize to untrained perturbations. Twelve healthy adults and 15 people with PD underwent 25 forward and 25 backward translations of the support surface, eliciting backward, and forward protective steps, respectively. We assessed whether: (1) performance improved over one day of practice, (2) changes were retained 24 h later, and (3) improvements generalized to untrained (lateral) postural responses. People with PD and healthy adults improved postural response characteristics, including center of mass displacement after perturbations (p < 0.001), margin of stability at first footfall (p = 0.001), step latency (p = 0.044), and number of steps (p = 0.001). However, unlike controls, improvements in people with PD occurred primarily in the first block of trials. Improvements were more pronounced during backward protective stepping than forward, and with the exception of step latency, were retained 24 h later. Improvements in forward–backward stepping did not generalize to lateral protective stepping. People with PD can improve protective stepping over the course of 1 day of perturbation practice. Improvements were generally similar to healthy adults, and were retained in both groups. Perturbation practice may represent a promising approach to improving protective postural responses in people with PD; however, additional research is needed to understand how to enhance generalization.

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Author information

Authors and Affiliations

  1. Veterans Affairs Salt Lake City Health Care System (VASLCHCS), Salt Lake City, UT, USA

    Daniel S. Peterson

  2. Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004-0698, USA

    Daniel S. Peterson

  3. Department of Neurology, Oregon Health and Science University, Portland, OR, USA

    Bauke W. Dijkstra & Fay B. Horak

  4. Veterans Affairs Portland Health Care System (VAPORHCS), Portland, OR, USA

    Fay B. Horak

Authors
  1. Daniel S. Peterson
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  2. Bauke W. Dijkstra
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  3. Fay B. Horak
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Correspondence to Daniel S. Peterson.

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Conflicts of interest

Dr. Horak and OHSU have an equity/interest in APDM, a company that may have a commercial interest in the results of the study. This potential conflict of interest has been reviewed and managed by the Research and Development Committee at the Portland VA Medical Center and OHSU.

Funding

This work was supported by grants from the United States Department of Veteran’s Affairs Rehabilitation Research and Development Service (Career Development Award-1: #I01BX007080; PI: DP) and VA Merit Award (E1075-R; PI: FH), the National Institutes of Health (R01 AG006457 29 PI: FH), and the Medical Research Foundation of Oregon (Early Investigator Award; PI: DP). The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

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Peterson, D.S., Dijkstra, B.W. & Horak, F.B. Postural motor learning in people with Parkinson’s disease. J Neurol 263, 1518–1529 (2016). https://doi.org/10.1007/s00415-016-8158-4

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  • DOI: https://doi.org/10.1007/s00415-016-8158-4

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