Analogy learning in Parkinson's disease: A proof-of-concept study

Abstract

Background/Aims: Analogy learning is a motor learning strategy that uses biomechanical metaphors to chunk together explicit rules of a to-be-learned motor skill. This proof-of-concept study establishes the feasibility and potential benefits of analogy learning in enhancing stride length regulation in people with Parkinson's disease. Methods: Walking performance of thirteen individuals with Parkinson's disease was analysed using a Codamotion analysis system. An analogy instruction: ‘following footprints in the sand’ was practised over eight walking trials. Single- and dual-task (motor and cognitive) conditions were measured before training, immediately after training and 4 weeks post training. Finally, an evaluation form was completed to examine the intervention's feasibility. Findings: Data from 12 individuals (6 females and 6 males, mean age 70, Hoehn and Yahr grade I–III) were analysed; one person withdrew due to back problems. In the single-task condition, statistically and clinically relevant improvements were obtained. A positive trend towards reducing dual-task costs after the intervention was demonstrated, supporting the relatively implicit nature of the analogy. Participants reported that the analogy was simple to use and became easier over time. Conclusions: Analogy learning is a feasible and potentially implicit (i.e. reduced working memory demands) intervention to facilitate walking performance in people with Parkinson's disease.

The Effects of Implicit and Explicit Motor Learning in Gait Rehabilitation of People After Stroke: Protocol for a Randomized Controlled Trial (Preprint)

“…It has been reported that the analogy should lead to the desired biomechanical movement and that preferably the analogy should contain a meaningful component to the participant 28,29 . Alongside the feasibility, also trends towards better walking performance after the analogy interventions were found, which demonstrate the potential of analogy learning in clinical practice 27,28 . However, to further establish the effectiveness of analogy learning in clinical gait rehabilitation, larger sample sizes and other research designs using a control condition are required.…”

“…Within the implicit condition the concept of analogy learning is the leading approach as it has shown to adopt characteristics of implicit motor learning 24,27,28 and provides therapists with a practical and feasible guideline to organise gait training. To choose and develop appropriate analogies, the same procedure as used in Kleynen et al, is followed 28 .…”

“…For example, the analogy "imagine as if you are walking over a frozen lake" has been used in gait rehabilitation to facilitate lifting and placing the foot while walking 28 . With regards to gait rehabilitation, small pilot studies have reported that analogies can be used in a feasible manner to facilitate walking performance 27,28 . It has been reported that the analogy should lead to the desired biomechanical movement and that preferably the analogy should contain a meaningful component to the participant 28,29 .…”

Implicit and explicit motor learning interventions for gait in people after stroke: a process evaluation of a randomized controlled trial

“…Within this RCT an implicit and explicit motor learning walking intervention for people after stroke was evaluated. Based on scientific evidence [2,7,8,11] and expert experiences (practice based evidence) an intervention guideline was developed that outlined precisely how the treatments (implicit and explicit conditions) were supposed to be delivered. The guideline for both interventions was comparable in terms of dose (three sessions per week over a 3-week period) and intensity (30 minutes per session).…”

“…It can be a creative process as the analogy should reflect correct movement pattern and preferably be meaningful to the participant [7]. Examples of analogies to facilitate walking are reported ( Table 3), also a few other analogies to facilitate gait have been described by Kleynen et al [7] and Jie et al [8]. We hope that sharing the delivered analogies (Table 3) may function as a source of inspiration Tailored implicit and explicit motor learning walking interventions can be applied in a feasible manner to people after stroke who are in the chronic phase of recovery.…”