Parkinson's Disease (PD) motor rehabilitation can improve clinical balance and disease severity measures. However, clinical scales cannot identify changes in specific neural pathways, and therefore may not be able to discriminate between remediative and compensatory changes to underlying neural mechanisms during rehabilitation. Our long-term goal is to discriminate between remediation and compensation during effective PD rehabilitation, which would significantly improve our understanding of response to treatment in individuals with PD as well as potentially in other neurological conditions. In contrast to clinical measures, we will study neuromuscular activation measured with electromyography (EMG) as a direct window into the neuromotor activity of individuals with PD before and after 24 weeks of adapted tango rehabilitative dance classes, which is an effective rehabilitative intervention with low attrition. We will quantify neuromotor deficits and recovery before and after rehabilitation using our sensorimotor response model (SRM), which was developed to quantify brainstem-mediated EMG responses evoked during perturbations to standing balance in young individuals as well as in animal models. We will use a novel experimental paradigm to determine whether motor improvements associated with rehabilitation are due to remediative changes in basal ganglia-brainstem pathways or due to compensatory changes in cerebellar-brainstem pathways. Previous studies of perturbation responses during standing balance demonstrate that basal ganglia pathways are used to adapt neural control parameters to new contexts immediately, whereas cerebellar pathways are used to adapt to new contexts slowly, over repeated trials. Therefore, we will examine the timecourse of adaptation of SRM parameters over repeated perturbation trials in novel stance widths. We predict that immediate changes in SRM parameters in novel stance widths will reflect basal ganglia-brainstem remediation, whereas slowly adapting changes will reflect cerebellar compensation. After rehabilitation, we predict that increased magnitudes of immediate changes will reflect basal ganglia-brainstem remediation, whereas increased speed of slowly adapting changes will reflect cerebellar-brainstem compensation. Further, we predict that SRM parameters can serve as biomarkers to identify differences in pathways underlying motor deficits across participants with PD throughout rehabilitation.

Public Health Relevance

Mobility and quality of life are often greatly impaired in individuals with Parkinson's disease (PD), at great costs to them and their loved ones. Rehabilitation can improve mobility somewhat. However, our rehabilitative techniques are limited because we do not know whether rehabilitation remediates underlying problems within the nervous system, or reinforces compensatory strategies that may be beneficial in the short term, but that may limit longer-term possibilities for improvement. Here, we propose to record and analyze the activity of muscles in individuals with PD before and after they undergo a rehabilitation intervention in order to determine whether the intervention improves motor impairments through remediation or compensation. This work may eventually lead to a greater understanding of the neuropathophysiology of PD as well as improved rehabilitative treatments.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Exploratory/Developmental Grants (R21)
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Motor Function, Speech and Rehabilitation Study Section (MFSR)
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Michel, Mary E
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Emory University
Biomedical Engineering
Schools of Medicine
United States
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McKay, J Lucas; Lang, Kimberly C; Ting, Lena H et al. (2018) Impaired set shifting is associated with previous falls in individuals with and without Parkinson's disease. Gait Posture 62:220-226
Allen, Jessica L; McKay, J Lucas; Sawers, Andrew et al. (2017) Increased neuromuscular consistency in gait and balance after partnered, dance-based rehabilitation in Parkinson's disease. J Neurophysiol 118:363-373
McKay, J Lucas; Ting, Lena H; Hackney, Madeleine E (2016) Balance, Body Motion, and Muscle Activity After High-Volume Short-Term Dance-Based Rehabilitation in Persons With Parkinson Disease: A Pilot Study. J Neurol Phys Ther 40:257-68
Puntkattalee, M Jane; Whitmire, Clarissa J; Macklin, Alix S et al. (2016) Directional acuity of whole-body perturbations during standing balance. Gait Posture 48:77-82
Ting, Lena H; Chiel, Hillel J; Trumbower, Randy D et al. (2015) Neuromechanical principles underlying movement modularity and their implications for rehabilitation. Neuron 86:38-54