Influence of Autonomy on Motor Learning in People With Parkinson's Disease

The goal of this clinical trial is to explore the benefits of autonomy supported learning in patients with Parkinson's disease. The main questions to answer are: Whether autonomy supported learning can benefit motor learning in PD patients Whether autonomy supported learning can enhance intrinsic motivation and/ or information processing of PD patients in learning a new task. Whether autonomy supported learning can facilitate cortical excitability change after practicing a new task. Participants will be recruited into two groups (Self-control group, SC; and yoked group, YK) to learn a finger-pressing trajectory matching task Participants in SC group will have choice over feedback schedule during trial practice Participants in YK group will receive feedback with no-choice during trial practice Researchers will compare the retention test performance to see if autonomy supported learning will lead to better learning effect.

Autonomy is the sense of learner to actively participate in determining their own behaviour. The present study aims to investigate whether an autonomy supported practice (with self-controlled feedback) would benefit adults with Parkinson's disease (PD), along with increased intrinsic motivation, information processing and cortical excitability. Two groups of healthy adults and two groups of PD patients will be recruited to learn a finger-pressing trajectory matching task. Participants will be allocated in either a self-control group (choice over feedback schedule), or a yoked group (receive feedback with no-choice). Learning will be assessed on the second day and one week later, along with an error estimation of learners' own performance to represent their information processing ability. Cortical excitability and inhibition will be assessed via transcranial magnetic stimulation as indicators of cortical plasticity. Questionnaire regarding motivation will be assessed before and after practice trials. Study hypothesized that individual with PD would benefit from autonomy supported learning, with better performance, enhanced motivation and information processing, associates with change of cortical excitability

Participants will be able to choose over feedback schedule when practicing finger-pressing trajectory matching task.

Participants will receive feedback, which was determined by their counterpart in self-control group, with no-choice when practicing finger-pressing trajectory matching task.

The ability of learners to participate in determining their own behaviour, which is the feedback schedule regarding their practice performance in this study.

Overall performance accuracy relative to the target waveform was assessed using root mean square error (RMSE), which is the mean difference between the target waveform and the participant's movement trajectory calculated over their actual movement time.

A questionnaire with subscales of perceived competence and autonomy. Questions were either taken directly or modified from the IMI, regarding to the participants subjective motivation after completing their practice trials.

Participants will be instructed to estimate their error in RMSE after completing each trial in retention and transfer test. Error estimation is used to assess the cognitive processing of participants during the trials.

Transcranial magnetic stimulation (TMS) device (The Magstim Company Ltd, Whitland, UK) will be used to determine the neurophysiological changes of corticomotor excitability before and after the acquisition phase.

Inclusion Criteria: age above 20-years-old able to follow instructions to perform the tasks (Montreal Cognitive Assessment ≥ 24) no surgery and injury in upper extremities in recent 6 months Exclusion Criteria: other neurological disorders in addition to Parkinson's disease Parkinson's disease dementia symptom of severe tremor in upper extremities (score ≥ 3 in Question 15 to 18 of UPDRS-III) deep brain stimulation or pacemaker implanted medical history of seizure a blood-relative with history of epilepsy unstable medical conditions pregnancy

Carter MJ, Ste-Marie DM. Not all choices are created equal: Task-relevant choices enhance motor learning compared to task-irrelevant choices. Psychon Bull Rev. 2017 Dec;24(6):1879-1888. doi: 10.3758/s13423-017-1250-7.

Chiviacowsky S, Wulf G, Lewthwaite R, Campos T. Motor learning benefits of self-controlled practice in persons with Parkinson's disease. Gait Posture. 2012 Apr;35(4):601-5. doi: 10.1016/j.gaitpost.2011.12.003. Epub 2011 Dec 30.