Elsevier

Gait & Posture

Volume 35, Issue 4, April 2012, Pages 601-605
Gait & Posture

Motor learning benefits of self-controlled practice in persons with Parkinson's disease

https://doi.org/10.1016/j.gaitpost.2011.12.003Get rights and content

Abstract

The present study examined the effectiveness of a training method to enhance balance in people with PD, which could potentially reduce their risk for falls. Specifically, we investigated whether the benefits of the self-controlled use of a physical assistance device for the learning of a balance task, found previously in healthy adults, would generalize to adults with PD. Twenty-eight individuals with PD were randomly assigned to one of two groups, a self-control and a yoked (control) group. The task required participants to stand on a balance platform (stabilometer), trying to keep the platform as close to horizontal as possible during each 30-s trial. In the self-control group, participants had a choice, on each of 10 practice trials, to use or not to use a balance pole. Participants in the yoked group received the same balance pole on the schedule used by their counterparts in the self-control group, but did not have a choice. Learning was assessed one day later by a retention test. The self-control group demonstrated more effective learning of the task than the yoked group. Questionnaire results indicated that self-control participants were more motivated to learn the task, were less nervous, and less concerned about their body movements relative to yoked participants. Possible reasons for the learning benefits of self-controlled practice, including a basic psychological need for autonomy, are discussed.

Highlights

► Persons with Parkinson's disease practice a balance task (stabilometer). ► We compare learning in groups with and without self-controlled use of a balance pole. ► Self-controlled use of the pole enhances learning compared with no self-control. ► Self-controlled practice increases motivation and reduces nervousness. ► Satisfying people's need for autonomy promotes learning.

Introduction

Parkinson's disease (PD) is a well-known progressive neurological condition that is associated with disordered motor control [1]. People with PD show atypical behaviors such as postural instability, tremor at rest, rigidity, and bradykinesia [2]. Postural instability, considered a primary risk factor for falls in persons with PD [3], is related to increased latencies in response to perturbation, ankle muscle weakness, degraded perception of stability limits and disequilibrium [4]. About two thirds of individuals with PD report falling within the past 12 months [5]. At the very least, falling can have a detrimental effect on people's confidence and, more generally, their quality of life [6]. Thus, developing training methods that effectively improve balance and have the potential to reduce the risk of falling is an important endeavor [7].

Recent intervention studies aiming at challenging impaired systems in PD have shown encouraging results [8], indicating a potential for reversing or delaying disease progression in this population. Even though people with PD demonstrate slower learning rates than controls, their capability to learn motor skills is relatively preserved. For example, a reduction in postural instability in persons with PD was observed when they were given instructions that promoted an external focus of attention [9], similar to findings with unimpaired participants (for a review, see Wulf [10]). In another study [11], participants with PD demonstrated more effective learning of a linear-positioning task with a reduced frequency of feedback compared to those who were given feedback after every trial, similar to what previous studies have shown for adults without neurological disorders [12].

A practice method that has consistently been shown to have positive effects on the learning of motor skills in unimpaired participants is self-controlled practice. In self-controlled practice conditions, learners are given control over a certain aspect of the practice conditions. Their learning is typically compared with participants in a control condition who are yoked to each self-control participant. Studies have demonstrated more effective learning under self-controlled practice conditions, relative to yoked conditions, when participants could decide when to receive feedback about their performance [13], when to watch a video model of a skilled performer [14], or when to use a physical assistance device while learning a balance task [15], [16]. For example, in one study [16], learning to produce slalom-type ski movements on a ski-simulator was enhanced when (unimpaired) performers were allowed to decide, before each practice trial, when to use ski poles that have been shown to facilitate learning [17]. In a subsequent study with young healthy adults, the learning of another balance task (stabilometer) was enhanced by the self-controlled use of a balance pole [15] – even though it provided no actual advantage for the learning of this task, as shown in a pilot study. This finding, in particular, underscores the powerful role of self-control in the learning process.

The potential benefits of self-controlled practice have yet to be examined in persons with PD. Given the motor impairments in this population and, more specifically, their challenged postural stability, we deemed it important to investigate whether balance learning could be facilitated by granting participants control over the use of an assistive device (i.e., balance pole), relative to not having control (yoked group). Following a practice phase under different conditions (self-control versus yoked), learning was assessed by a delayed retention test without the assistive device. In addition to examining effects on learning, we used a customized questionnaire to assess potential influences on participants’ motivation, nervousness, and attentional focus as a function of practice conditions. As self-controlled practice presumably satisfies people's basic psychological need for autonomy [18], we hypothesized that participants would be more motivated to learn the task and perhaps show greater enjoyment of practicing. Also, we speculated that an increased sense of control or autonomy might reduce participants’ level of anxiety and nervousness, particularly when first acquiring the skill. Finally, under the assumption that self-controlled practice would enhance the learning of the task, we assumed that performers would be less inclined to consciously control their body movements (i.e., adopting an internal focus of attention), and perhaps direct more attention to the movements of the balance platform (i.e., external focus) [10].

Section snippets

Participants

Twenty-eight individuals with PD (18 men and 10 women), who were classified in Stages II and III on the Hoehn and Yahr scale [19], with an age range of 46–88 years (mean age of the self-control group: 67.92; yoked group: 66.57) participated in the study. During the experiment, participants were medicated for PD according to their own optimized schedule. Table 1 shows the participants’ characteristics. The study was approved by the university's ethics committee, and informed consent was obtained

Practice phase

Participants in the self-control group asked for the balance pole on 41% of the trials, on average, ranging from 30% to 70% (SD: 13.5%). Across practice, pole use remained relatively constant, but was somewhat lower at the beginning and end of the practice phase. More specifically, on Trials 1–10 the pole was used by 14%, 36%, 50%, 50%, 50%, 43%, 50%, 43%, 50%, and 29% of participants, respectively. Both groups increased their time in balance across practice trials, with the self-control group

Discussion

Participants with PD showed more effective learning of a challenging balance task when they were able to control the use of an ostensibly helpful assistive device (balance pole) compared with yoked control participants. This result is in line with the findings of previous studies with healthy participants [15], [16]. Participants in the present study chose to use the balance pole on 41% of the practice trials. This is similar to the frequency found by Hartman (2007) (i.e., 38%) in his study

Acknowledgment

This study received financial support from CNPq (National Council of Scientific and Technological Development), Brazil.
Conflict of interest statement

None of the authors has any conflict of interest.

References (32)

  • J.R. Playfer

    Falls and Parkinson's disease

    Age Ageing

    (2001)
  • G.M. Petzinger et al.

    Enhancing neuroplasticity in the basal ganglia: the role of exercise in Parkinson's disease

    Mov Disord

    (2010)
  • G. Wulf et al.

    External focus instructions reduce postural instability in individuals with Parkinson disease

    Phys Ther

    (2009)
  • G. Wulf

    Attention and motor skill learning

    (2007)
  • S. Chiviacowsky et al.

    Reduced frequency of knowledge of results enhances learning in persons with Parkinson's disease

    Front Psychol

    (2010)
  • C.J. Winstein et al.

    Reduced frequency of knowledge of results enhances motor skill learning

    J Exp Psychol Learn Mem Cogn

    (1990)
  • Cited by (73)

    • Acute exercise following skill practice promotes motor memory consolidation in Parkinson's disease

      2021, Neurobiology of Learning and Memory
      Citation Excerpt :

      We used a dynamic balancing task to examine participants’ motor learning performance, since balance training (i.e. postural motor learning) is a core component of motor rehabilitation in PD (Peterson, Dijkstra, & Horak, 2016). The stabilometer is widely used to study motor learning (Lewthwaite & Wulf, 2010; Mégrot & Bardy, 2006; Wulf & Lewthwaite, 2009; Wulf, Weigelt, Poulter, & McNevin, 2003), including PD populations (Chiviacowsky, Wulf, Lewthwaite, & Campos, 2012; Sehm et al., 2014; Steib et al., 2018). Furthermore, the device has already been reported to be appropriate as an ecologically valid device to investigate learning in complex motor skills (Wulf & Shea, 2002).

    View all citing articles on Scopus
    View full text