title: Impaired Retention of Motor Learning of Writing Skills in Patients with Parkinson's Disease with Freezing of Gait.
abstract: BACKGROUND
  Patients with Parkinson's disease (PD) and freezing of gait (FOG) suffer from more impaired motor and cognitive functioning than their non-freezing counterparts. This underlies an even higher need for targeted rehabilitation programs in this group. However, so far it is unclear whether FOG affects the ability for consolidation and generalization of motor learning and thus the efficacy of rehabilitation.
  
  
  OBJECTIVE
  To investigate the hallmarks of motor learning in people with FOG compared to those without by comparing the effects of an intensive motor learning program to improve handwriting.
  
  
  METHODS
  Thirty five patients with PD, including 19 without and 16 with FOG received six weeks of handwriting training consisting of exercises provided on paper and on a touch-sensitive writing tablet. Writing training was based on single- and dual-task writing and was supported by means of visual target zones. To investigate automatization, generalization and retention of learning, writing performance was assessed before and after training in the presence and absence of cues and dual tasking and after a six-week retention period. Writing amplitude was measured as primary outcome measure and variability of writing and dual-task accuracy as secondary outcomes.
  
  
  RESULTS
  Significant learning effects were present on all outcome measures in both groups, both for writing under single- and dual-task conditions. However, the gains in writing amplitude were not retained after a retention period of six weeks without training in the patient group without FOG. Furthermore, patients with FOG were highly dependent on the visual target zones, reflecting reduced generalization of learning in this group.
  
  
  CONCLUSIONS
  Although short-term learning effects were present in both groups, generalization and retention of motor learning were specifically impaired in patients with PD and FOG. The results of this study underscore the importance of individualized rehabilitation protocols.
authors: Neuromotor Rehabilitation Research Group-Department of Rehabilitation Sciences-KU, Leuven, Belgium.
authors: Elke
authors: E
authors: Heremans
authors: Neuromotor Rehabilitation Research Group-Department of Rehabilitation Sciences-KU, Leuven, Belgium.
authors: Evelien
authors: E
authors: Nackaerts
authors: Neuromotor Rehabilitation Research Group-Department of Rehabilitation Sciences-KU, Leuven, Belgium.
authors: Griet
authors: G
authors: Vervoort
authors: Neuromotor Rehabilitation Research Group-Department of Rehabilitation Sciences-KU, Leuven, Belgium.
authors: Sanne
authors: S
authors: Broeder
authors: Movement Control and Neuroplasticity Research Group-Department of Kinesiology-KU, Leuven, Belgium.
authors: Stephan P
authors: SP
authors: Swinnen
authors: Neuromotor Rehabilitation Research Group-Department of Rehabilitation Sciences-KU, Leuven, Belgium.
authors: Alice
authors: A
authors: Nieuwboer
mesh_terms: D000368:Aged; D000381:Agraphia / Q000209:etiology* / Q000534:rehabilitation; D001307:Auditory Perception; D001696:Biomechanical Phenomena; D003463:Cues; D005260:Female; D020233:Gait Disorders, Neurologic / Q000209:etiology* / Q000503:physiopathology; D006225:Hand / Q000503:physiopathology; D006801:Humans; D007859:Learning Disabilities / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008569:Memory Disorders / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D009048:Motor Skills; D010296:Parietal Lobe / Q000503:physiopathology; D010300:Parkinson Disease / Q000150:complications* / Q000503:physiopathology / Q000523:psychology / Q000534:rehabilitation; D011597:Psychomotor Performance / Q000502:physiology; D012153:Retention, Psychology / Q000502:physiology*; D014956:Writing