Cognitive Predictors of Responsiveness to Reactive Step Training in People with Parkinson’s Disease at Fall-Risk

Monaghan, Andrew S.; Hooyman, Andrew; Dibble, Leland E.; Mehta, Shyamal H.; Peterson, Daniel S.

doi:10.1016/j.neulet.2023.137517

Cited by 2 publications

(1 citation statement)

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“…The effect of TMT training on the practiced TMT perturbation task 33 and how cognitive status may predict responsiveness to training 41 have been published previously for this cohort. However, the current report is novel in focusing specifically on the generalizability of stepping improvements to an unpracticed tether-release task.…”

Section: Participantsmentioning

confidence: 99%

Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease

Monaghan,

Hooyman,

Dibble

et al. 2024

Journal of Neurologic Physical Therapy

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Background and Purpose: Reactive balance training improves reactive postural control in people with Parkinson disease (PwPD). However, the extent to which reactive balance training generalizes to a novel, unpracticed reactive balance task is unknown. This study aimed to determine whether reactive training stepping through support surface translations can be generalized to an unpracticed, instrumented tether-release task. Methods: Twenty-five PwPD (70.52 years ± 7.15; Hoehn and Yahr range 1-3) completed a multiple baseline, open-label, uncontrolled pre-post intervention study. Stepping was trained through a 2-week (6-session) intervention with repeated support surface translations. Performance on an untrained tether-release task (generalization task) was measured at 2 baseline assessments (B1 and B2, 2 weeks apart), immediately after the intervention (P1), and 2 months after training (P2). The tether-release task outcomes were the anterior-posterior margin of stability (MOS), step length, and step latency during backward and forward steps. Results: After support surface translation practice, tether-release stepping performance improved in MOS, step length, and step latency for both backward and forward steps compared to baseline (P < 0.05). Improvements in MOS and step length during backward and forward steps in the tether-release task, respectively, were related to stepping changes in the practiced task. However, the improvements in the generalization task were not retained for 2 months. Discussion and Conclusions: These findings support short-term generalization from trained balance tasks to novel, untrained tasks. These findings contribute to our understanding of the effects and generalization of reactive step training in PwPD. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content available at http://links.lww.com/JNPT/A465).

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Section: Participantsmentioning

confidence: 99%

Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease

Monaghan,

Hooyman,

Dibble

et al. 2024

Journal of Neurologic Physical Therapy

Self Cite

View full text Add to dashboard Cite

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Associating white matter microstructural integrity and improvements in reactive stepping in people with Parkinson’s Disease

Monaghan,

Ofori,

Fling

et al. 2024

Brain Imaging and Behavior

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Reactive steps are rapid responses after balance challenges. People with Parkinson's Disease demonstrate impaired reactive stepping, increasing fall risk. Although PwPD can improve steps through practice, the neural mechanisms contributing to improved reactive stepping in people with PD are poorly understood. This study investigated white-matter correlates of responsiveness to reactive step training in people with PD. Participants completed an eighteen-week multiple-baseline study consisting of two baseline assessments (B1 and B2) before training, a two-week, six-session training protocol, and two post-training assessments (immediate; P1) and two months after training (P2). Each assessment consisted of 3 backward reactive step trials. Outcomes included the anterior-posterior margin of stability, step length, and step latency. Tract-Based Spatial Statistics were performed to correlate white-matter microstructural integrity (fractional anisotropy and radial diffusivity) with retained improvements in reactive stepping at the two-month follow-up (P2-B2). Complete datasets were available from 22 participants. Greater retention of step length was associated with increased fractional anisotropy (better white-matter integrity) within the left anterior corona radiata (r = 0.54, p < 0.01), left posterior thalamic radiation (r = 0.54, p < 0.01), and right (r = 0.43, p = 0.04) and left (r = 0.0.40, p = 0.06) superior longitudinal fasciculi. Greater retention of step latency improvements was associated with lower radial diffusivity (greater white-matter integrity) within the left posterior (r = 0.60, p < 0.01) and anterior corona radiata (r = 0.61, p < 0.01). These ndings highlight the importance of white-matter microstructural integrity in motor learning and retention processes in PD and may inform the development of targeted interventions to improve balance in people with PD.

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Cognitive Predictors of Responsiveness to Reactive Step Training in People with Parkinson’s Disease at Fall-Risk

Cited by 2 publications

References 40 publications

Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease

Generalization of In-Place Balance Perturbation Training in People With Parkinson Disease

Associating white matter microstructural integrity and improvements in reactive stepping in people with Parkinson’s Disease

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