BALANCE DEFICIENCY IS ASSOCIATED TO LACK IN IMPLICIT LEARNING WITH PEOPLE OF PARKINSON DISEASE: IMPLICATIONS FOR REHABILITATION

Pimentel Piemotne M.E.^1,2, D'Alencar M.¹, Helene A.³, Galves A.³

¹University of Sao Paulo, Physical Therapy, Sao Paulo, Brazil, ²Neuromat Project, Sao Paulo, Brazil, ³University of Sao Paulo, Neuromat, Sao Paulo, Brazil

Background: Postural instability is an incapacitating disorder, whose increase the risk of falls and the level of dependence in PD patients, marking a significant stage of disease onset. Evidence suggests that deficits in automatic control, hallmark symptom of PD, is associated with the lack of balance. Although all the neural processes of motor automaticity are not fully understood, the main role of implicit system for the process is a consensus.

Purpose: To investigate the relation between implicit learning capacity and balance efficiency in people with Parkinson Disease (PPD).

Methods: Fifteen PPD in stage 1 of Hoehn and Yahr classification, 15 patients in stages 2 and 3, and 15 healthy matched control individuals, were exposed to a probabilistic implicit learning experiment based on a computational game named “Goalkeeper” (GG) which simulated a soccer game and a balance evaluation by Balance Evaluation Systems Test (BESTest). On session 1 the participants performed the balance evaluation. On session 2, two days after session 1, participants were exposed to five trials of GG. Finally, on session 3, seven days after session 2, the performance in the GG was reassessed. All PD patients were tested in ON period of dopaminergic reposition medication.

Results: The ANOVA for repeated measure showed that PPD were able to improve their performance in the GG (p .01, ES>.90). However, as expected, the improvement was relatively greater for the control subjects as compared to that seen for PPD (p .001, ES>.095). Most important, the decline in balance control was correlated with the ability to improve the performance in the Goalkeeper game (R=.75, p .01).

Conclusion(s): The decline in balance efficiency is associates to deficiency in probabilistic implicit learning in patients with PD.

Implications: It seems important to consider this evidence in order to achieve the improved comprehension about the postural instability and to plan more efficient therapeutic approaches to improve the balance efficiency in patients with PD.

Funding acknowledgements: APESP Research, Innovation and Dissemination Center for Neuromathematics (grant #2013/ 07699-0 , S.Paulo Research Foundation).

Topic: Neurology

Ethics approval: All patients signed a term approved by Faculty of Medicine – University of São Paulo

All authors, affiliations and abstracts have been published as submitted.