Postural motor learning in Parkinson’s disease: The effect of practice on continuous compensatory postural regulation

• Published in: Gait & posture Vol. 57; pp. 299 - 304
• Main Authors: Van Ooteghem, Karen, Frank, James S., Horak, Fay B.
• Format: Journal Article
• Language: English
• Published: England Elsevier B.V 01.09.2017
• Subjects: Aged; Automatic postural response; Case-Control Studies; Continuous perturbation; Female; Humans; Learning - physiology; Male; Middle Aged; Motor learning; Parkinson Disease - physiopathology; Parkinson Disease - psychology; Parkinson Disease - rehabilitation; Parkinson’s disease; Physical Therapy Modalities; Postural Balance - physiology; Posture; Psychomotor Performance; Treatment Outcome; Continuous perturbation; Automatic postural response; Motor learning; Parkinson’s disease; Posture
• ISSN: 0966-6362; 1879-2219
• DOI: 10.1016/j.gaitpost.2017.06.021

•We examine learning for postural responses critical to fall avoidance.•Learning is demonstrated using rates and retention of performance improvements.•Impaired posture control does not preclude learning of automatic postural responses.•A shift from feedback toward anticipatory control drives performance improvements. 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. Eleven participants with moderate PD (68±6.4years; H&Y: 2–3) on their usual medication maintained balance on a platform that oscillated forward and backward with variable amplitude and constant frequency. Participants completed 42 trials during one training session, and retention and transfer tests following a 24-h delay. Performance was measured by comparing spatial and temporal measures of whole-body centre of mass (COM) with platform displacements. Learning was compared between participants with PD and previously reported, age-matched older adults (Van Ooteghem et al., 2010). Although postural responses in participants with PD were impaired compared to control participants, a majority of PD participants improved their postural responses with practice as revealed by reduced COM displacements and improved phase relationships between COM and platform motion. Rates of improvement were comparable between groups demonstrating preserved adaptive capacity for participants with PD. Similar to control participants, the PD group moved toward anticipatory COM control as a strategy for improving stability, exhibited short-term retention of performance improvements, and demonstrated generalizability of the learned responses. Rate of improvement with practice, but not retention, was related to severity of motor impairments. Patients with moderate PD on medication demonstrate retention of improvements in automatic postural responses with practice suggesting that intrinsic postural motor learning is preserved in this group.