The supplementary motor area is thought to contribute to the generation of anticipatory postural adjustments (which act to stabilize supporting body segments prior to movement), but its precise role remains unclear. In addition, participants with Parkinson’s disease (PD) exhibit impaired function of the supplementary motor area as well as decreased amplitudes and altered timing of the anticipatory postural adjustment during step initiation, but the contribution of the supplementary motor area to these impairments also remains unclear. To determine how the supplementary motor area contributes to generating the anticipatory postural adjustment and to the impaired anticipatory postural adjustments of participants with PD, we examined the voluntary steps of 8 participants with PD and 8 participants without PD, before and after disrupting the supplementary motor area and dorsolateral premotor cortex, in separate sessions, with 1-Hz repetitive transcranial magnetic stimulation. Both groups exhibited decreased durations of their anticipatory postural adjustments after repetitive transcranial magnetic stimulation over the supplementary motor area but not over the dorsolateral premotor cortex. Peak amplitudes of the anticipatory postural adjustments were unaffected by repetitive transcranial magnetic stimulation to either site. The symptom severity of the participants with PD positively correlated with the extent that repetitive transcranial magnetic stimulation over the supplementary motor area affected the durations of their anticipatory postural adjustments. The results suggest that the supplementary motor area contributes to the timing of the anticipatory postural adjustment and that participants with PD exhibit impaired timing of their anticipatory postural adjustments, in part, due to progressive dysfunction of circuits associated with the supplementary motor area.

NCT00056563 and NCT01076452.

Current medical educational theory encourages the development of competency-based curricula. The Accreditation Council for Graduate Medical Education's 6 core competencies for resident education (medical knowledge, patient care, professionalism, interpersonal and communication skills, practice-based learning, and systems-based practice) have been embraced by medical schools as the building blocks necessary for becoming a competent licensed physician. Many medical schools are therefore changing their educational approach to an integrated model in which students demonstrate incremental acquisition and mastery of all competencies as they progress through medical school. Challenges to medical schools include integration of preclinical and clinical studies as well as development of learning objectives and assessment measures for each competency. The Undergraduate Education Subcommittee (UES) of the American Academy of Neurology (AAN) assembled a group of neuroscience educators to outline a longitudinal competency-based curriculum in medical neuroscience encompassing both preclinical and clinical coursework. In development of this curriculum, the committee reviewed United States Medical Licensing Examination content outlines, Liaison Committee on Medical Education requirements, prior AAN-mandated core curricula for basic neuroscience and clinical neurology, and survey responses from educators in US medical schools. The newly recommended curriculum provides an outline of learning objectives for each of the 6 competencies, listing each learning objective in active terms. Documentation of experiences is emphasized, and assessment measures are suggested to demonstrate adequate achievement in each competency. These guidelines, widely vetted and approved by the UES membership, aspire to be both useful as a stand-alone curriculum and also provide a framework for neuroscience educators who wish to develop a more detailed focus in certain areas of study.