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

40 Participants Needed

Trial Summary

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 data supports the effectiveness of the treatment Delayed Feedback for Parkinson's Disease?

Research shows that delayed auditory feedback can improve speech clarity in conditions similar to Parkinson's, and closed-loop auditory feedback has been effective in improving walking abilities in Parkinson's patients. Additionally, visual feedback has been shown to help with movement control in Parkinson's, suggesting that delayed feedback might also be beneficial. ^{1 2 3 4 5}

How does the Delayed Feedback treatment for Parkinson's disease differ from other treatments?

Delayed Feedback treatment for Parkinson's disease is unique because it involves using time-delayed visual information to help patients control their movements. This approach focuses on improving the sensory-motor processing by altering the timing of visual feedback, which is different from traditional treatments that primarily target motor symptoms with medication. ^{3 4 6 7 8}

What is the purpose of this trial?

Learning deficits are frequent in individuals with Parkinson's Disease. Clear feedback is integral because through feedback individuals know whether they should stick with an action that they have been doing (if the feedback is positive), or change their course of action (if the feedback is negative). Learning though immediate feedback has been shown to be depended on the brain chemical dopamine that is disrupted in individuals with Parkinson's Disease. During learning, feedback can also be presented after a delay. The investigators propose that learning through delayed feedback will lead to greater learning in individuals with Parkinson's Disease, since learning through delayed feedback does not rely on dopamine. During the proposed paradigm, participants with Parkinson's Disease complete a multiple-choice test. After making their selection on the multiple-choice test, they either see feedback immediately or are given feedback 25 minute later after reviewing their selection on the multiple-choice test. The investigators hypothesize that participants will learn better when they are provided with delayed feedback.

Research Team

Ekaterina Dobryakova, PhD

Principal Investigator

Kessler Foundation

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

DAF as instrumental treatment for dysarthria in progressive supranuclear palsy: a case report. [2019]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Closed-loop auditory feedback for the improvement of gait in patients with Parkinson's disease. [2016]

3. United States pubmed.ncbi.nlm.nih.gov

Delayed visual feedback and movement control in Parkinson's disease. [2019]

4. England pubmed.ncbi.nlm.nih.gov

The effects of visual feedback during a rhythmic weight-shifting task in patients with Parkinson's disease. [2018]

5. England 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. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Feedback and delays in neurological diseases: a modeling study using dynamical systems. [2019]

7. England pubmed.ncbi.nlm.nih.gov

Initiation and execution of predictable and unpredictable movements in Parkinson's disease. [2019]

8. England pubmed.ncbi.nlm.nih.gov

Visuomotor control in patients with Parkinson's disease. [2017]