Delayed Feedback for Parkinson's Disease

Overseen By Kai Sucich, MA

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: Kessler Foundation

Disqualifiers: Epilepsy, Multiple sclerosis, Brain tumors, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests whether people with Parkinson's Disease learn better with feedback given 25 minutes after a task, rather than immediately. Researchers believe delayed feedback might enhance learning because it does not depend on dopamine, a brain chemical affected by Parkinson's. Participants will take multiple-choice tests and receive feedback either immediately or after a delay. The study seeks individuals with Parkinson's Disease who do not have other neurological conditions and possess a good cognitive score (basic thinking and memory abilities). As an unphased trial, it offers participants the chance to contribute to groundbreaking research that could improve learning strategies for those with Parkinson's Disease.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that this method is safe for individuals with Parkinson's Disease?

Research has shown that the main treatment under study for Parkinson's Disease, known as delayed feedback, is generally well-tolerated. Delayed feedback does not rely on dopamine, a brain chemical often imbalanced in individuals with Parkinson's. This suggests it might enhance learning without causing additional dopamine-related issues.

Although specific side effects of delayed feedback are not detailed, the study emphasizes a learning method rather than a drug or surgery, indicating a lower risk of harmful effects. This approach focuses on timing and teaching rather than introducing new chemicals to the body, making it appear safe for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Delayed Feedback for Parkinson's Disease because it offers a unique approach to managing symptoms. Unlike traditional treatments like Levodopa or dopamine agonists that aim to restore dopamine levels, Delayed Feedback focuses on improving motor control through real-time feedback techniques. This method could enhance patients' ability to manage their movements more effectively, potentially reducing the reliance on medication and its associated side effects. By harnessing technology to provide immediate feedback, this approach may offer a novel way to improve quality of life for individuals with Parkinson’s Disease.

What evidence suggests that delayed feedback is effective for learning in Parkinson's Disease?

Research suggests that delayed feedback might benefit people with Parkinson's Disease. Typically, learning relies on immediate feedback, which involves dopamine, a brain chemical affected by Parkinson's. In contrast, delayed feedback does not depend on dopamine, potentially making learning easier for those with Parkinson's. Studies indicate that delayed feedback could improve the speed and clarity of speech in people with Parkinson's. Although results vary, the concept is that delayed feedback might enhance learning by bypassing dopamine reliance, possibly leading to better patient outcomes. ^{6 7 8 9 10}

Who Is on the Research Team?

Ekaterina Dobryakova, PhD

Principal Investigator

Kessler Foundation

Are You a Good Fit for This Trial?

This trial is for individuals with Parkinson's Disease who can learn and remember well enough to score above 24/30 on a cognitive test called the Montreal Cognitive Assessment, which ensures they do not have dementia.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

1-2 weeks

Testing

Participants complete a multiple-choice test with immediate or delayed feedback

1 day

1 visit (in-person)

Follow-up

Participants are monitored for response accuracy and learning outcomes

1-2 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Delayed Feedback

Trial Overview The study tests if people with Parkinson's Disease learn better when feedback is delayed. Participants take a multiple-choice test and receive feedback either immediately or after a 25-minute delay to see which method improves learning more.

How Is the Trial Designed?

Group I: Parkinson Disease Experimental Treatment 1 Intervention

Participants with Parkinson Disease; Single group.

Who Is Running the Clinical Trial?

Kessler Foundation

Lead Sponsor

Trials

190

Recruited

11,300+

Published Research Related to This Trial

Increased time delays in visual feedback during a tracking task lead to different oscillation patterns in healthy individuals compared to patients with neurological diseases, highlighting the impact of feedback delays on motor control.

A preliminary model suggests that these oscillations are influenced by two feedback loops in the motor control system, with noise factors improving the model's accuracy for Parkinson's patients but not for those with cerebellar disease.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feedback and delays in neurological diseases: a modeling study using dynamical systems. Beuter, A., Bélair, J., Labrie, C., et al.[2019]

Individuals with Parkinson's disease (PD) can benefit from augmented visual feedback (VF) to improve their motor functioning during weight-shifting tasks, showing a significant reduction in tracking errors when using real-time feedback.

However, patients with PD are more negatively affected by incongruent visual information compared to healthy controls, leading to reduced movement amplitude as a conservative strategy to avoid performance breakdown.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The effects of visual feedback during a rhythmic weight-shifting task in patients with Parkinson's disease. van den Heuvel, MRC., Daffertshofer, A., Beek, PJ., et al.[2018]

A 59-year-old male with progressive supranuclear palsy showed significant improvements in speech rate, vocal intensity, and overall intelligibility after using a delayed auditory feedback device for three months.

The subject and his family reported high satisfaction with the device, suggesting it may be an effective tool for enhancing communication in individuals with speech disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

DAF as instrumental treatment for dysarthria in progressive supranuclear palsy: a case report. Hanson, WR., Metter, EJ.[2019]

Closed-loop auditory feedback significantly improves walking speed (average 10.72% increase) and stride length (average 6.77% increase) in patients with Parkinson's disease compared to when the device is off, with 87.5% of patients showing improved walking speed.

This method not only enhances immediate walking performance but also has residual effects, with 9.09% improvement in walking speed and 6.52% in stride length observed after a short rest, indicating its potential for long-term therapeutic use.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Closed-loop auditory feedback for the improvement of gait in patients with Parkinson's disease. Baram, Y., Aharon-Peretz, J., Badarny, S., et al.[2016]

Antiparkinsonian medication improves visuomotor control in patients with Parkinson's disease (PD), enhancing their ability to respond to visual stimuli and make sensory predictions, but does not restore the stability of the neuromuscular system.

Despite medication improving some aspects of sensory-motor processing, PD patients still exhibit decreased control precision and increased response delays compared to healthy controls, indicating ongoing deficits in their sensory-motor system.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Visuomotor control in patients with Parkinson's disease. Chen, J., Ho, SL., Lee, TM., et al.[2017]

Open- and closed-loop cueing significantly improved turning characteristics in people with Parkinson's disease, as evidenced by reduced freezing of gait and improved turning smoothness during a one-minute turning task with 25 subjects with freezing of gait and 18 without.

While both cueing methods enhanced turning smoothness, they also resulted in slower turning velocity and fewer turns compared to baseline, indicating a trade-off that needs further investigation for practical mobility improvements.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Assessment of the ability of open- and closed-loop cueing to improve turning and freezing in people with Parkinson's disease. Mancini, M., Smulders, K., Harker, G., et al.[2019]

In a study involving nine patients with Parkinson's disease and age-matched controls, both groups performed similarly on a tracking task, indicating that Parkinson's patients can execute preprogrammed movements without relying on visual feedback.

However, in a reaction time task, Parkinson's patients struggled to use predictable cues to improve their reaction times, suggesting they have difficulty initiating movements even when given prior information.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Initiation and execution of predictable and unpredictable movements in Parkinson's disease. Bloxham, CA., Mindel, TA., Frith, CD.[2019]

In a study comparing healthy individuals and Stage II-III Parkinson's disease (PD) patients, it was found that some PD patients can still use visual information effectively for motor control, similar to healthy individuals, despite the presence of movement challenges.

The introduction of a time delay in visual feedback affected finger tracking differently; while healthy individuals showed complex oscillations in movement, half of the PD patients did not due to factors like reduced gain and increased tremor amplitude, indicating variability in how PD affects motor control.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Delayed visual feedback and movement control in Parkinson's disease. Beuter, A., Milton, JG., Labrie, C., et al.[2019]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC2661057/

The effects of delayed and frequency shifted feedback on ... Delayed auditory feedback (DAF) has been assessed as a rate reduction and intelligibility enhancing tool in patients with Parkinson's Disease (PD) for some ...

2. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0166432822003692

Review Delay discounting in Parkinson's disease We explored delay discounting in Parkinson disease. · Patients with Parkinson disease (PD) show steeper delay discounting than healthy controls.

3. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/29758227/

Effects of Feedback Delay on Learning From Positive and ... A Bayesian analysis of the data supports the conclusion that feedback timing did not affect the learning bias in the patients. These results ...

4. journals.plos.org journals.plos.org/plosone/article?id=10.1371/journal.pone.0058264

Failure of Delayed Feedback Deep Brain Stimulation for ... This suggests that delayed feedback DBS in Parkinson's disease may boost rather than suppress synchronization and is unlikely to be clinically successful. The ...

5. movementdisorders.onlinelibrary.wiley.com movementdisorders.onlinelibrary.wiley.com/doi/10.1002/mds.29796

Long‐Term Follow‐Up of the LEAP Study: Early Versus ... To date, there is no treatment that slows Parkinson's disease (PD) progression. Levodopa remains the most effective symptomatic oral treatment ...

6. clinicaltrials.gov clinicaltrials.gov/study/NCT06217484

Investigation of Effects of Delayed Feedback on Non-motor ... Learning though immediate feedback has been shown to be depended on the brain chemical dopamine that is disrupted in individuals with Parkinson's Disease.

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6374315/

Motor Learning Deficits in Parkinson's Disease (PD) and ... This narrative review will evaluate the effect of PD on motor learning and the effect of motor learning deficits on response to physical therapy and training ...

8. nature.com nature.com/articles/s41531-025-00923-2

Predictive modeling to uncover Parkinson's disease ... Our study aimed to systematically identify demographic and clinical factors linked to delayed PD diagnosis by using longitudinal data from large ...

9. sciencedirect.com sciencedirect.com/science/article/pii/S1353802025006352

Defining 'OFF' time in device-aided therapy criteria for ... OFF-time is a key parameter in determining suitability for device-aided therapy (DAT). OFF-periods are complex and experienced by each patient differently.

10. ninds.nih.gov ninds.nih.gov/current-research/focus-disorders/parkinsons-disease-research/parkinsons-disease-challenges-progress-and-promise

Parkinson's Disease: Challenges, Progress, and Promise A preliminary study of isradipine in people with PD demonstrated relative safety. Researchers hope to confirm results in a larger, ongoing ...