Van Ooteghem Karen, Frank James S, Horak Fay B
Department of Kinesiology, University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L 3G1, Canada.
Department of Kinesiology, University of Waterloo, 200 University Ave. W., Waterloo, ON, N2L 3G1, Canada.
Gait Posture. 2017 Sep;57:299-304. doi: 10.1016/j.gaitpost.2017.06.021. Epub 2017 Jun 28.
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.
尽管平衡训练被认为是治疗帕金森病（PD）平衡障碍最有效的方法，但很少有研究探讨PD患者的平衡控制学习能力是否保持完好。本研究旨在确定PD患者的自动姿势反应学习能力是否得以保留。
11名中度PD患者（68±6.4岁； Hoehn-Yahr分级：2-3级）在服用常规药物的情况下，在一个以可变幅度和恒定频率前后摆动的平台上保持平衡。参与者在一次训练 session 中完成42次试验，并在延迟24小时后进行保留和转移测试。通过比较全身质心（COM）的空间和时间测量值与平台位移来测量表现。将PD患者与先前报道的年龄匹配的老年人（Van Ooteghem等人，2010年）的学习情况进行比较。
尽管与对照组相比，PD患者的姿势反应受损，但大多数PD患者通过练习改善了姿势反应，这表现为COM位移减少以及COM与平台运动之间的相位关系改善。两组之间的改善率相当，表明PD患者具有保留的适应能力。与对照组相似，PD组朝着预期的COM控制方向发展，以此作为提高稳定性的策略，表现出短期的表现改善保留情况，并证明了所学反应的可推广性。练习的改善率而非保留率与运动障碍的严重程度相关。
服用药物治疗的中度PD患者通过练习表现出自动姿势反应改善的保留情况，这表明该组患者的内在姿势运动学习能力得以保留。
