自主權對於促進巴金森氏症患者動作學習之效果

Abstract

背景：巴金森氏症患者因動機、認知功能以及動作學習的障礙，導致其動作表現或學習新動作的成效不佳。因此，找尋促進巴金森氏症患者動作學習的方法，將可增進臨床復健的成效。自主權是指個人擁有自我決定的權利和能力，在環境中能夠自主做出選擇和決定。在動作學習中給與學習者選擇練習的參數能夠增加他們的自主權，進而增加學習的内在動機與認知資源的投入。自主權已被廣泛的證實可以促進健康年輕人的動作學習能力，且背後的神經生理機制已被初步討論。然而目前只有一篇研究探討自主權對巴金森氏症患者動作學習的影響，因此本研究欲探討給與自主控制回饋時機對於巴金森氏症患者動作學習的效益，以及其相關神經生理機制。

研究目的：探討提供巴金森氏症患者自主權對於動作學習之成效，及其相關神經生理機制。

研究方法：本研究招募原發性巴金森氏症患者，並依照受試者性別、年紀與疾病嚴重度輪流分配至自主組和共軛組以進行手指按壓任務的學習。其中自主組在練習時能夠選擇得到回饋的時機，共軛組則依照自主組的選擇接收相同時機的回饋。每位受試者在實驗第一天接受基本評估，包括情緒、認知功能與動作能力評估。在基本評估之後，將以經顱磁刺激術記錄受試者大腦皮質的興奮性，之後進行手指按壓任務的練習。此外，受試者在練習後需要填寫動機量表以及學習策略問卷。受試者在第二天將進一步練習手指按壓任務，並馬上以手指按壓任務測試觀察其立即留存效果，同時以受試者自評誤差分數觀察他們對任務表現的知覺。之後再進行經顱磁刺激術記錄受試者在學習之後大腦皮質的興奮性變化。受試者在練習之後的第七天將進行追蹤測試及經顱磁刺激術評估。

結果：共有三十二位受試者完成試驗，其中十六位被分配至自主組，十六分配至共軛組。經過兩天的訓練之後，自主組與共軛組的手指按壓任務準確率皆顯著增加（p <0.001）。兩組受試者在第二天的留存評估中表現相近，但自主組在第七天的評估中較共軛組有更好的動作任務留存（group-by-time interaction p = 0.040）。 學習策略問卷的結果顯示多數受試者在感知到良好和不好的表現後皆想要獲得回饋，而兩組的動機量表分數沒有顯著的差異。自評誤差分數則顯示，兩組在第二天與第七天的評估中都有相近的表現。 經顱磁刺激術的數據顯示，自主組的皮質脊髓興奮性在第七天的追蹤測試中有顯著的增加，而共軛組則沒有明顯的變化（group-by-time interaction p = 0.041）。

總結：提供巴金森氏症患者自主權有助於促進其動作學習的成效，且伴隨皮質興奮性的增加。然而實驗沒有發現顯著的訊息處理和動機效應，顯示巴金森患者能夠自主控制回饋時機，可能是透過其他機制促進其學習效應。

關鍵字：巴金森氏症、自主權、動作學習、皮質興奮性、經顱磁刺激術

Background: People with Parkinson's disease (PD) are known to have impaired motor learning and low motivation, which pronouncedly limit the effectiveness of training or acquiring new motor skills. Exploring methods to promote motor learning and motivation can thus enhance the effectiveness of clinical rehabilitation for people with PD. Autonomy refers to the sense of learner to actively participate in determining their own behavior. Providing learners with choices in the learning process (i.e., self-controlled practice) can increase their autonomy, thereby enhancing intrinsic motivation and cognitive resources for learning. Selfcontrolled practice has been shown to promote motor learning abilities, and the associated neurophysiological mechanisms have been discussed in healthy young adults. However, there is only one study to date intended to explore the effect of autonomy on motor learning in PD, and the neurophysiological mechanisms have not yet been studied.

Study purpose: The present study aimed to investigate whether an self-controlled practice would benefit motor learning for individuals with PD.

Method: This study recruited people with idiopathic PD. Participants were matched in pairs and consecutively allocated into the self-control group (SELF) and the yoked group (YOKED) to practice a finger-pressing trajectory-matching task. Participants in the SELF group had the choice to either receive performance feedback or not during practice, while those in the YOKED group received feedback according to the choices made by their counterparts. Each participant underwent baseline assessments on the first day (D1), including emotional status, cognitive function, and motor ability assessments. Following the assessments, neurophysiological outcomes were assessed with transcranial magnetic stimulation (TMS) before practicing the finger-pressing task. Additionally, participants needed to complete the motivation questionnaire and report their strategy for requesting feedback after the practice sessions. On the second day (D2), participants underwent additional practice of the finger-pressing tasks. Later, a retention and a transfer test were conducted to observe their immediate learning effects. At the same time, participants’ selfreported error estimation scores were used to assess their perception of task performance. TMS was also used to record changes in cortical excitability after the learning session. On the seventh day (D7) of the experiment, participants returned to the lab and completed a followup retention test, along with the TMS assessments.

Result: 32 participants were recruited into the study, with 16 assigned to the SELF group and 16 to the YOKED group. After two days of training, the accuracy of finger-pressing tasks increased significantly in both the SELF and the YOKED groups (p < 0.001). While both groups showed similar performance at the D2 retention test, the SELF group had greater retention of the motor task than the YOKED group on D7 (group-by-time interaction p = 0.040).

When interviewing the participants’ strategy for requesting feedback, it seemed that most participants preferred receiving feedback after good or bad trials equally. The results from the motivation questionnaire showed no significant difference between the two groups. Regarding the error estimation scores, both the SELF and YOKED groups showed similar ability in estimating their motor performance.

As for the TMS data, participants in the SELF group showed an increase in resting motor evoked potential (MEP) from D2 to D7, while the YOKED group showed similar resting MEP on D2 and D7 (group-by-time interaction p = 0.041).

Conclusion: Providing self-controlled feedback to patients with PD might benefit motor learning, accompanied by an increase in corticomotor excitability. However, this study did not find significant changes in the cognitive-processing ability or motivation in performing the task, suggesting that there might be other mechanisms that facilitated motor learning in people with PD.

Keywords: Parkinson’s disease, autonomy, motor learning, corticomotor excitability, transcranial magnetic stimulation