Structured Abstract
Parkinson's Disease Structured Abstract - P #5
Practice reduces bradykinesia in aiming task
CITATION: Platz, T., Brown, R. G., & Marsden, C. D. (1998). Training improves the speed of aimed movements in Parkinson's disease. Brain, 121, 505-514.
LEVEL OF EVIDENCE: IB2b
RESEARCH OBJECTIVE/QUESTION
The purpose of this study was to investigate the extent to which bradykinesia can be influenced by practice and specific training strategies, such as the use of external rhythmic cues.
DESIGN
|
x |
RCT |
|
Single Case |
|
Case Control |
| |
Cohort |
|
Before-After |
|
Cross Sectional |
SAMPLING PROCEDURE Convenience sampling recruited from outpatient clinics at the National Hospital for Neurology and Neurosurgery, London, UK. Participants were randomly assigned to one of two conditions: with and without auditory rhythmic cues. Control participants were age and gender matched.
SAMPLE
|
N = 30 |
Mean age treatment grp = 63.9 years,
control grp = 1.4 years |
Male = 16 |
Female = 14 |
NUMBER OF PARTICIPANTS IN HOEHN & YAHR'S CLASSIFICATIONS OF PARKINSON'S DISEASE
STAGE I = NR (range of participants in each stage not reported)
STAGE II = Mean stage for participants in treatment group = 2.25
STAGE III = NR
STAGE IV = NR
EXCLUSION/INCLUSION CRITERIA: Included if right-handed. None had marked tremor, dyskinesia, or susceptibility to sudden "off" medication periods. None had general disabling conditions or dementia. Control participants had no history of neurological or musculoskeletal problems, none had neurological signs at the time of testing, and none were taking drugs affecting the central nervous system.
OUTCOMES
| |
Life roles |
|
Tasks |
|
Activities |
| |
Abilities/habits |
x |
Capacities |
OUTCOME AREAS
|
Outcome area |
Measures |
Reliability |
Validity |
|
Kinematic variables (total movement time, maximum acceleration) |
Digitizing tablet with a pen-like stylus (connected to a computer) |
good |
NR |
NR=Not Reported
INTERVENTION
Description
Participants were asked to move a stylus in a sagittal plane to a circular target at a distance of 200mm. They were instructed to make smooth, single movements that were both fast and accurate.
Condition without cues - movement began after two tones signalled ready and go.
Condition with cues - half of all subjects were asked to use the rhythm of five equally spaced tones to control their movement speed, starting the movement after the third tone and finishing by the fifth tone.
Knowledge of results regarding accuracy was provided after every fifth trial.
All participants did 15 trials of aiming with each limb, 100 trials of training with one arm (short break after fifty trials), 15 trials with each limb, and another 15 trials after a 1 hour break.
Who delivered
NR
Setting
NR
Frequency
1 day
Duration
1 day
RESULTS
Both the participants with Parkinson's disease and the controls had a decrease in overall movement time (F(1,26) = 51.9, p < .001); however, a greater decrease in movement time was found in Parkinson's disease and control participants who received no cueing than in participants who received cueing (F(1,26) 9.6, p < .01). Parkinson's disease and control participants showed an increase in maximal acceleration of movement, but only the control subjects showed a greater change in the un-cued condition (F(1,13) = 9.8, p < .01).
CONCLUSIONS
Biases - none
Contrary to expectation, auditory rhythmic cues did not enhance improvement in the speed of aimed movements in either Parkinson's disease or control participants. Participants with Parkinson's disease showed improvement in movement time with training in an aiming task. Overall, this was a well-controlled study.
COMMENTARY
This study has implications for motor learning of clients with Parkinson's disease in OT practice. This study showed that bradykinetic movements of participants with Parkinson's disease improved with practice. However, this study only used an aiming task and further study would need to address real-life tasks such as ADL. Also, auditory rhythmic cues were not found to improve motor performance on aiming tasks, and participants who received no cues showed greater improvement.
Terminology used in this document is based on two systems of classification current at the time the evidence-based literature reviews were completed: Uniform Terminology for Occupational Therapy Practice-Third Edition (AOTA, 1994) and International Classification of Functioning, Disability and Health (ICIDH-2) (World Health Organization [WHO], 1999). More recently, the Uniform Terminology document was replaced by Occupational Therapy Practice Framework: Domain and Process (AOTA, 2002), and modifications to ICIDH-2 were finalized in the International Classification of Functioning, Disability and Health (WHO, 2001).
This work is based on the evidence-based literature review completed by Susan Murphy, ScD, OTR/L, and Linda Tickle-Degnen, PhD, OTR/L, FAOTA.
For more information about the Evidence-Based Literature Review Project, contact the Practice Department at the American Occupational Therapy Association, 301-652-6611, x 2040.
Copyright 2003 American Occupational Therapy Association, Inc. All rights reserved. This material may be reproduced and distributed without prior written consent.
