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Parkinson DiseasecueingNCT05818189

Cortical Correlates of Gait in Parkinson's Disease: Impact of Medication and Cueing

A study testing Personalized tactile cueing and Fixed tactile cueing in people with Parkinson Disease, run by Oregon Health and Science University at 1 site in United States.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The purpose of the study is to determine the effects of a novel, personalized, tactile cueing system on gait automaticity. The researchers hypothesized that step-synchronized tactile cueing will reduce prefrontal cortex activity (improve automaticity) and improve gait variability (as well as gait speed). Read more about this study

Who is it for?
Ages 45 to 85 years
Conditions the study is for
Parkinson Disease
What is being tested?
Personalized tactile cueing and Fixed tactile cueing
Type of treatment
Medical device
Could I receive a placebo?
No, everyone receives an active treatment
How many people
60 participants
Where
1 siteUnited States
Study dates
15 Jan 2025to 31 Jan 2028
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 45 to 85 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Diagnosis of idiopathic Parkinson's Disease from movement disorders neurologist with the United Kingdom Brain Bank criteria of bradykinesia with 1 or more of the following - rest tremor, rigidity, and balance problems not from visual, vestibular, cerebellar or proprioceptive conditions
  • Without musculoskeletal or peripheral or central nervous system disorders (other than PD) that could significantly affect their balance and gait
  • All subjects will be capable of following directions for the protocols and to give informed consent.
  • Hoehn \& Yahr Levels II-III.

Who cannot join

  • Severe dyskinesia that may affect quality of fNIRS.
  • Major musculoskeletal or neurological disorders, structural brain disease, epilepsy, acute illness or health history, other than Parkinson's Disease, significantly affecting gait and turning i.e., peripheral neuropathy with proprioceptive deficits (detected as lack of toe proprioception assessed during the neurological exam at Day 1), musculoskeletal disorders, vestibular problem, head injury, stroke.
  • Montreal cognitive assessment (MoCA) score < 21 or dementia that precludes consent to participate or ability to follow testing procedures
  • Inability to stand or walk for 2 minutes without an assistive device.
  • Idiopathic Parkinson's Disease exclusion criteria: Parkinson plus syndromes such as progressive supranuclear palsy, multiple system atrophy, or corticobasal syndrome or implanted electrodes for deep brain stimulation (DBS), possible vascular parkinsonism, current use of dopamine-blocking agents or cholinesterase inhibitor (as may affect Prefrontal cortical activity while walking).

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Francesa Alcalá, B.S. contact

503-913-3691

alcalaf@ohsu.edu

Graham Harker, MPH contact

503-418-2601

harkerh@ohsu.edu

United States1 site, 1 recruiting
  • Oregon Health and Science University

    Portland, Oregon, 97239

    Francesca Alcalá, B.S., 503-913-3691, alcalaf@ohsu.edu

    Graham Harker, MPH, 503-418-2601, harkerg@ohsu.edu

    Recruiting

Other trials in United States

About this study

The purpose of the study is to determine the effects of a novel, personalized, tactile cueing system on gait automaticity. The researchers hypothesized that step-synchronized tactile cueing will reduce prefrontal cortex activity (improve automaticity) and improve gait variability (as well as gait speed). The researchers predict that improved automaticity with improved gait variability will be associated with increased activation of other than prefrontal cortical areas while walking (i.e., sensory-motor). To determine the effects of cueing, 60 participants with PD from will be randomized into one, of two, cueing interventions: 1) personalized, step-synchronized tactile cueing and 2) tactile cueing at fixed intervals as an active control group. In addition, the researchers will explore the feasibility and potential benefits of independent use of tactile cueing during a week in daily life for a future clinical trial.

This project will characterize the cortical correlates of gait automaticity, the changes in gait automaticity with cueing in people with Parkinson's Disease, and how these changes translate to improvement in gait and turning. The long-term goal is to unravel the mechanisms of impaired gait automaticity in Parkinson's Disease.

Read the detailed description

Cortical correlates of gait automaticity in Parkinson's disease: impact of cueing

A well-recognized hallmark of healthy walking is automaticity, defined as the ability of the nervous system to successfully coordinate movement with minimal use of attention-demanding, executive resources. It has been proposed that many walking abnormalities in people with Parkinson's disease (PD) are characterized by a shift in locomotor control from healthy automaticity to compensatory, executive control. This shift to less automaticity is potentially detrimental to walking performance as executive control strategies are not optimized for locomotor control, place excessive demands on a limited cognitive reserve, and continuously require attention. It has been hypothesized that as gait becomes more variable, as in people with Parkinson's Disease, control of gait is less automatic, i.e., requires more prefrontal cortex involvement. However, as gait variability is not a direct measure of automaticity, it is controversial whether it truly reflects impaired gait automaticity or impaired gait stability (i.e., dynamic balance). The recent development of wireless, functional, near-infrared spectroscopy (fNIRS) of the brain provides more direct, physiological measures of automaticity, such as reduced prefrontal cortex activity. However, the contribution of other cortical areas to the concept of gait automaticity is largely unknown. Here, for the first time, the researchers will use a full cap fNIRS system to monitor cortical activity in multiple brain areas and wearable, inertial sensors to determine how cognitive abilities, levodopa, and cueing influence gait automaticity.

The effects of cognitive dysfunction and interventions on gait in people with Parkinson's Disease are complex. Impaired executive function has been associated with impaired gait and balance in PD, but it is not known if this relationship is due to the inability to compensate for poor basal ganglia control of gait automaticity with increased prefrontal cortex activity while walking. Sensory cueing may increase gait speed and reduce prefrontal activity but unlike levodopa, it may result in reduced gait variability due to enhanced automaticity. The researchers recently developed a novel type of personalized (triggered by the subject's own walking pattern), step-synchronized tactile stimulation on the wrists to improve the quality of gait and turning in people with Parkinson's Disease. The researchers will now compare the effects of cognitive dysfunction, dopaminergic medication, and tactile cueing on the quality of gait and turning and investigate whether improvements reflect changes in prefrontal activity.

This project will characterize the cortical correlates of gait automaticity, the changes in gait automaticity with cueing in people with PD, and how these changes translate to improvement in gait and turning. The long-term goal is to unravel the mechanisms of impaired gait automaticity in Parkinson's Disease.

The purpose of the study is to determine the effects of a novel, personalized, tactile cueing system on gait automaticity. The researchers hypothesized that step-synchronized tactile cueing will reduce prefrontal cortex activity (improve automaticity) and improve gait variability (as well as gait speed). We predict that improved automaticity with improved gait variability will be associated with increased activation of other than prefrontal cortical areas while walking (i.e., sensory-motor). To determine the effects of cueing, 60 participants with PD from will be randomized into one, of two, cueing interventions: 1) personalized, step-synchronized tactile cueing and 2) tactile cueing at fixed intervals as an active control group. A secondary analysis will explore whether the effect of cueing on gait automaticity is influenced by cognitive dysfunction. In addition, we will explore the feasibility and potential benefits of independent use of tactile cueing during a week in daily life for a future clinical trial. We will explore feasibility and efficacy of cueing in daily life comparing data of gait and turning from a week of continuous monitoring without and with using the tactile cueing. In addition, we will test whether any retention on gait and turning is present by adding a third week of continuous monitoring.

Being tested
Personalized tactile cueing, Fixed tactile cueing
Keywords
Tactile cueing, Gait, Turning, Cortical activity
Medical subject headings
Parkinson Disease

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Personalized tactile cueingDevice

    Also called personalized

    We will use as an external cue, a system of tactile cueing with the purpose of enhancing proprioceptive inputs, in the form of real-time(synchronized to the gait heel strike), closed-loop tactile feedback signaling left and right stance times while walking. Also, the participants use the same system cueing in closed-loop feedback during daily life for one week.

  • Fixed tactile cueingDevice

    Also called fixed

    We will use as an external cue, a system of tactile cueing with the purpose of enhancing proprioceptive inputs, in the form of real-time, open-loop(fixed rhythm) tactile feedback signaling left and right stance times while walking. Also, the participants use the same system cueing in open-loop feedback during daily life for one week.

Study groups in NCT05818189
Study groupRoleWhat they receive
Personalized cueingExperimentalPersonalized, step-synchronized tactile cueing, enhancing proprioceptive inputs, in the form of real-time, closed-loop tactile feedback signaling left and right stance times while walking
Receives: Device: Personalized tactile cueing
Fixed cueingActive comparatorTactile cueing at fixed intervals, enhancing proprioceptive inputs, in the form of open-loop tactile feedback (fixed rhythm) signaling left and right stance times while walking
Receives: Device: Fixed tactile cueing

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Prefrontal cortex activity

    Oxygenated hemoglobin over the prefrontal cortex measures by fNIRS

    Measured: day 1

  2. Parietal cortex activity

    Oxygenated hemoglobin over the parietal cortex measures by fNIRS

    Measured: day 1

  3. Stride time variability

    Variability of stride time during 2 minute walking

    Measured: day 1

  4. Local Dynamic Stability

    Stability during gait is assessed by phase dependent local dynamic stability (LDS) measures of the trunk acceleration while walking

    Measured: day 1

  5. Turn duration

    Average duration of 360 turning while performing a 1 minute turning in place task

    Measured: day 1

  6. Turn jerk

    Average turning smoothness while performing a 1 minute turning in place task

    Measured: day 1

Secondary outcomes (13)
  1. Supplementary motor area cortical activity

    Oxygenated hemoglobin over the SMA cortex measures by fNIRS

    Measured: day 1

  2. Occipital cortical activity

    Oxygenated hemoglobin over the visual cortex measures by fNIRS

    Measured: day 1

  3. Gait speed

    Average gait speed during 2 minute walking

    Measured: day 1

  4. Gait speed variability

    Variability of gait speed during 2 minute walking

    Measured: day 1

  5. Stride time

    Average stride duration during 2 minute walking

    Measured: day 1

  6. Stride length

    Average stride length during 2 minute walking

    Measured: day 1

  7. Stride length variability

    Variability of stride length during 2 minute walking

    Measured: day 1

  8. Turn duration variability

    Variability of turning duration while performing a 1 minute turning in place task

    Measured: day 1

  9. Turn jerk variability

    Variability of turning smoothness while performing a 1 minute turning in place task

    Measured: day 1

  10. Number of steps during turning

    Average number of steps while performing a 1 minute turning in place task

    Measured: day 1

  11. Number of steps during turning variability

    Variability of number of steps while performing a 1 minute turning in place task

    Measured: day 1

  12. Turn velocity

    Average turning velocity while performing a 1 minute turning in place task

    Measured: day 1

  13. Turn velocity variability

    Variability of turning velocity while performing a 1 minute turning in place task

    Measured: day 1

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted18 Apr 2023
  2. Study start15 Jan 2025
  3. Primary completion1 Oct 2027 (estimated)
  4. Study completion31 Jan 2028 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
60 participants with PD from Aim I, will be randomized into one, of two, cueing interventions: 1) personalized, step-synchronized tactile cueing and 2) tactile cueing at fixed intervals as an active control group. We will analyze the immediate effects of the cueing intervention on gait automaticity. In addition, we will explore the feasibility and potential benefits of independent use of tactile cueing during a week in daily life for a future clinical trial.
Masking
Triple blind
Who is masked
Participant, Investigator, Outcomes assessor
Enrolment
60 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05818189
Sponsor's protocol ID
R01HD110389
Other IDs
R01HD110389
Acronym
cueing
Status last verified
Dec 2025
First submitted
5 Apr 2023
Last updated
17 Dec 2025
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Upon reasonable request, we can share de-identified data related to study outcomes measures.

Publications

  • Burgos PI, Liu W, Silva-Batista C, Baker-Alcala F, Carlson-Kuhta P, King LA, Horak FB, Chung KA, Lapidus JA, Mancini M. Personalized versus fixed tactile cueing in Parkinson's disease: Protocol for a randomized controlled trial on gait automaticity. PLoS One. 2025 Nov 21;20(11):e0336859. doi: 10.1371/journal.pone.0336859. eCollection 2025.

    PubMed 41270079

Questions about this trial

What is this clinical trial studying?

A study testing Personalized tactile cueing and Fixed tactile cueing in people with Parkinson Disease, run by Oregon Health and Science University at 1 site in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 4 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 17 Dec 2025. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Francesa Alcalá, B.S. (503-913-3691, alcalaf@ohsu.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Prefrontal cortex activity (time frame: day 1). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05818189, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 17 Dec 2025.

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