CONTROL Walking Study
| Status: | Not yet recruiting |
|---|---|
| Conditions: | Healthy Studies |
| Therapuetic Areas: | Other |
| Healthy: | No |
| Age Range: | 65 - Any |
| Updated: | 1/5/2019 |
| Start Date: | May 1, 2019 |
| End Date: | March 31, 2023 |
| Contact: | David J Clark, DSc |
| Email: | David.Clark1@va.gov |
| Phone: | (352) 376-1611 |
Cerebral Networks of Locomotor Learning and Retention in Older Adults
Older adults often experience substantial deficits in walking ability, especially for walking
tasks that are more complex such as obstacle crossing. This is due in part to changes in the
brain that make performance of physical and cognitive tasks more difficult. Rehabilitation
can help to improve walking ability, but effective rehabilitation is time consuming and
expensive. New approaches are needed to improve the efficiency of rehabilitation so that
gains in walking ability are widely attainable. A promising strategy is to focus on enhancing
motor learning, which is defined as improved ability to perform a motor task due to practice
or experience. The investigators will investigate the use of non-invasive brain stimulation
to increase motor learning and retention of the newly learned walking skills. The
investigators will also use neuroimaging to assess brain characteristics that explain how
motor learning works. The knowledge gained from this study is expected to contribute to
better understanding of mechanistic targets and intervention approaches to improve
rehabilitation of walking.
tasks that are more complex such as obstacle crossing. This is due in part to changes in the
brain that make performance of physical and cognitive tasks more difficult. Rehabilitation
can help to improve walking ability, but effective rehabilitation is time consuming and
expensive. New approaches are needed to improve the efficiency of rehabilitation so that
gains in walking ability are widely attainable. A promising strategy is to focus on enhancing
motor learning, which is defined as improved ability to perform a motor task due to practice
or experience. The investigators will investigate the use of non-invasive brain stimulation
to increase motor learning and retention of the newly learned walking skills. The
investigators will also use neuroimaging to assess brain characteristics that explain how
motor learning works. The knowledge gained from this study is expected to contribute to
better understanding of mechanistic targets and intervention approaches to improve
rehabilitation of walking.
Aging often leads to substantial declines in walking function, especially for walking tasks
that are more complex such as obstacle crossing. This is due in part to a lack of continued
practice of complex walking (sedentary lifestyle) combined with age-related deficits of brain
structure and the integrity of brain networks. Neurorehabilitation can contribute to recovery
of lost walking function in older adults, but major and persistent improvements are elusive.
A cornerstone of neurorehabilitation is motor learning, defined as an enduring change in the
ability to perform a motor task due to practice or experience. Unfortunately, in most
clinical settings, the time and cost demands of delivering a sufficiently intensive motor
learning intervention is not feasible. There is a need for research to develop strategies for
enhancing motor learning of walking ("locomotor learning") in order to improve the
effectiveness of neurorehabilitation.
The objective of this study is to use non-invasive brain stimulation to augment locomotor
learning and to investigate brain networks that are responsible for locomotor learning in
mobility-compromised older adults. The investigators have shown that frontal brain regions,
particularly prefrontal cortex, are crucial to control of complex walking tasks. The
investigators' neuroimaging and neuromodulation studies also show that prefrontal cortex
structure and network connectivity are important for acquisition and consolidation of new
motor skills. However, a major gap exists regarding learning of walking tasks. The proposed
study is designed to address this gap. The investigators' pilot data from older adults shows
that prefrontal transcranial direct current stimulation (tDCS) administered during learning
of a complex obstacle walking task contributes to multi-day retention of task performance. In
the proposed study the investigators will build upon this pilot work by conducting a full
scale trial that also investigates mechanisms related to brain structure, functional
activity, and network connectivity. The investigators will address the following specific
aims:
Specific Aim 1: Determine the extent to which prefrontal tDCS augments the effect of task
practice for retention of performance on a complex obstacle walking task.
Specific Aim 2: Determine the extent to which retention of performance is associated with
individual differences in baseline and practice-induced changes in brain measures (including
gray matter volume and brain network segregation).
Specific Aim 3: Investigate the extent to which tDCS modifies resting state network
segregation.
The investigators anticipate that prefrontal tDCS will augment retention of locomotor
learning, and that the data will provide the first evidence of specific brain mechanisms
responsible for locomotor learning/retention in older adults with mobility deficits. This new
knowledge will provide a clinically feasible intervention approach as well as reveal
mechanistic targets for future interventions to enhance locomotor learning and retention.
that are more complex such as obstacle crossing. This is due in part to a lack of continued
practice of complex walking (sedentary lifestyle) combined with age-related deficits of brain
structure and the integrity of brain networks. Neurorehabilitation can contribute to recovery
of lost walking function in older adults, but major and persistent improvements are elusive.
A cornerstone of neurorehabilitation is motor learning, defined as an enduring change in the
ability to perform a motor task due to practice or experience. Unfortunately, in most
clinical settings, the time and cost demands of delivering a sufficiently intensive motor
learning intervention is not feasible. There is a need for research to develop strategies for
enhancing motor learning of walking ("locomotor learning") in order to improve the
effectiveness of neurorehabilitation.
The objective of this study is to use non-invasive brain stimulation to augment locomotor
learning and to investigate brain networks that are responsible for locomotor learning in
mobility-compromised older adults. The investigators have shown that frontal brain regions,
particularly prefrontal cortex, are crucial to control of complex walking tasks. The
investigators' neuroimaging and neuromodulation studies also show that prefrontal cortex
structure and network connectivity are important for acquisition and consolidation of new
motor skills. However, a major gap exists regarding learning of walking tasks. The proposed
study is designed to address this gap. The investigators' pilot data from older adults shows
that prefrontal transcranial direct current stimulation (tDCS) administered during learning
of a complex obstacle walking task contributes to multi-day retention of task performance. In
the proposed study the investigators will build upon this pilot work by conducting a full
scale trial that also investigates mechanisms related to brain structure, functional
activity, and network connectivity. The investigators will address the following specific
aims:
Specific Aim 1: Determine the extent to which prefrontal tDCS augments the effect of task
practice for retention of performance on a complex obstacle walking task.
Specific Aim 2: Determine the extent to which retention of performance is associated with
individual differences in baseline and practice-induced changes in brain measures (including
gray matter volume and brain network segregation).
Specific Aim 3: Investigate the extent to which tDCS modifies resting state network
segregation.
The investigators anticipate that prefrontal tDCS will augment retention of locomotor
learning, and that the data will provide the first evidence of specific brain mechanisms
responsible for locomotor learning/retention in older adults with mobility deficits. This new
knowledge will provide a clinically feasible intervention approach as well as reveal
mechanistic targets for future interventions to enhance locomotor learning and retention.
Inclusion Criteria:
- age 65 years or older
- preferred 10m walking speed < 1.1 m/s
- self-report of "some difficulty with walking tasks, such as becoming tired when
walking a quarter mile, or when climbing two flights of stairs, or when performing
household chores."
- Willingness to be randomized to either study group and to participate in all aspects
of study assessment and intervention
Exclusion Criteria:
- Diagnosed neurological disorder or injury of the central nervous system, or
observation of symptoms consistent with such a condition (Alzheimer's, Parkinson's,
stroke, etc.)
- Contraindications to non-invasive brain stimulation (e.g., metal in head, wound on
scalp)
- Contraindications to magnetic resonance imaging (e.g., metal in body, claustrophobia,
etc).
- Use of medications affecting the central nervous system
- severe arthritis, such as awaiting joint replacement
- severe obesity (body mass index > 35)
- current cardiovascular, lung or renal disease; diabetes; terminal illness
- myocardial infarction or major heart surgery in the previous year
- cancer treatment in the past year, except for nonmelanoma skin cancers and cancers
having an excellent prognosis (e.g., early stage breast or prostate cancer)
- current diagnosis of schizophrenia, other psychotic disorders, or bipolar disorder
- uncontrolled hypertension at rest (systolic > 180 mmHg and/or diastolic > 100 mmHg)
- bone fracture or joint replacement in the previous six months
- current participation in physical therapy for lower extremity function or
cardiopulmonary rehabilitation
- current enrollment in any clinical trial
- difficulty communicating with study personnel, and/or non-English speaking
- planning to relocate out of the area during the study period
- clinical judgment of investigative team regarding safety or non-compliance
We found this trial at
1
site
Gainesville, Florida 32608
Principal Investigator: David J. Clark, DSc
Phone: 352-376-1611
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