臺灣博碩士論文加值系統

背景：巴金森氏症是一個因基底核退化而造成的神經系統退化性疾病，它不僅會造成 動作上的徵狀如姿勢不穩跟動作緩慢，亦會影響認知功能。巴金森氏症患者受到影響 的認知功能包含工作記憶能力、視覺空間處理能力及動作學習能力。與健康人相比， 巴金森氏症患者的動作學習能力較差，尤其是內隱式順序學習。迄今為止，還沒有有效的治療方法(包括使用多巴胺藥物)可以改善巴金森氏症患者的內隱式順序學習之能力。 由健康年輕人的研究發現，單次有氧運動可以有效促進動作學習。 然而，目前還不清楚單次有氧運動是否也可以改善並促進巴金森氏症患者的內隱式順序學習。 另外，有氧運動對於動作學習的益處之相關的神經生理機制尚未被建立。
研究目的：本篇研究的主要目的為探討單次有氧運動對巴金森氏症患者之內隱式順序學習的效果。另外，本研究亦探討有氧運動與動作學習間的神經生理變化。
研究方法：本研究流程納入了30 位巴金森氏症患者並隨機分成運動組及非運動組。 另納入 15 位健康人作為控制組。所有人在實驗的第一天接受基本評估包括認知及動作行為評估。在基本評估後，進行穿顱磁刺激術評估來測試大腦皮質的興奮性，然後進行序列反應時間按鍵測試的動作學習。在練習完後，運動組進行 20 分鐘的中強度的腳踏車運動，而巴金森非運動組及健康人控制組安靜的坐著閱讀 20 分鐘。所有人在運動或閱讀後，接著馬上進行穿顱磁刺激術評估及序列反應時間按鍵測試留存測試。受試者在練習後的第二天跟第七天，再次進行留存測試及接受穿顱磁刺激術評估。組間之序列反應時間按鍵測試及穿顱磁刺激術之數據則採用重複測量變異數分析。
結果：在第一天的練習中，三組的表現都有進步（F = 80.935，p <0.005，ηp2= 0.658）。 序列反應時間按鍵測試顯示三組受試者在整個練習過程中都學習順序，而巴金森患者的進步程度似乎小於控制組（F = 1.979，p = 0.036, ηp2= 0.070）。運動組之巴金森氏症患者在第2天表現較差，在第7天表現出更大的進步。 閱讀組之巴金森氏症患者組在第2天和第7天表現較差。 控制組在所三天的評估都持續進步。 序列反應時間按鍵測試結果表明，單次中等強度的有氧運動可以促進巴金森氏症患者內隱式順序學習的記憶鞏固過程。 這結果跟穿顱磁刺激術數據僅顯示控制組中第一天前測和第二天之間（p = 0.005），以及第一天前測和第二天之間（p = 0.019）之休息動作誘發電位的興奮性顯著降低。
結論：此篇研究顯示單次有氧運動有助於巴金森氏症患者之內隱式順序學習，並於第七天的表現較佳；未來可以於病患學習順序性動作後，安排有氧運動來促進動作學習。

Background: Parkinson's disease (PD) is a degenerative neurological disease caused by the degradation of the basal ganglia. It not only affects motor symptoms, such as postural instability or bradykinesia, but also influences cognitive functions. Cognitive impairments in PD include deteriorated working memory, visuospatial processing ability, and motor learning. Impaired motor learning ability, especially implicit sequence learning, has been widely demonstrated in people with PD. To date, no effective treatment approach (including the use of dopaminergic medication) has been established to restore implicit sequence learning ability in PD. Evidence conducted on healthy young adults proposed that a single bout of aerobic exercise can enhance motor learning. However, it was yet unclear whether a single bout of aerobic exercise could also facilitate implicit sequence learning in people with PD. Additionally, the neurophysiological mechanisms associated with the benefits of aerobic exercise on motor learning have not been determined.
Purpose: The purpose of this study was to investigate the effect of a single bout of aerobic exercise on implicit sequence learning in people with PD. We also aimed to determine the neurophysiological changes associated with motor learning and aerobic exercise.
Methods: Thirty individuals with PD and 15 non-disable adults were included in this study. People with PD were randomly assigned into 2 groups: exercise group (PD+AEX) and non-exercise group (PD–AEX). Non-disabled adults served as the control group (CON). All participants performed baseline assessments on the first day, including cognitive and motor functions. Following baseline evaluations, corticomotor excitability was assessed with transcranial magnetic stimulation (TMS). The participants were then instructed to perform the serial reaction time task (SRTT). After completion of the SRTT, the participants in the PD+AEX group were required to ride on a stationary bicycle with moderately high intensity for 20 minutes, while the participants in the PD–AEX and CON were required to sit and read for 20 minutes. Immediately after the aerobic exercise or reading break, the participants were then required to complete a retention test of the SRTT and received TMS assessment again. The participants returned to the lab on the 2nd day and the 7th day to perform the delayed retention tests of the SRTT. Corticomotor excitability was also assessed with TMS on each visit. Repeated measures analysis of variance was used to compare the group differences in SRTT performance as well as TMS outcomes.
Result: All three groups showed improved performance throughout the 1st day practice (F = 80.935, p < 0.005, ηp2 = 0.658). The SRTT performance showed that all 3 groups had learnt the sequence throughout practice while PD patients appeared to show lesser degree of improvement than the control subject (F = 1.979, p = 0.036, ηp2 = 0.074). PD+AEX group performed worse on 2nd day and showed greater improvement on 7th day. PD-AEX group performed worse 2nd day and the 7th day. CON group kept improving in all the assessment time points. TMS data only revealed significant decreased excitability on resting motor evoked potential in the CON group between 1st day pre and 2nd day tests (p = 0.005), and also between 1st day pre and 7th day tests (p = 0.019).
Conclusion: This study demonstrated that a single bout of moderate intensity aerobic exercise could facilitate implicit sequence learning in people with PD. The findings provide important clinical implication that clinicians could arrange a single bout of aerobic exercise after motor sequence skill learning.

誌謝...................................................................................................................................i
中文摘要...........................................................................................................................ii
Abstract.............................................................................................................................iv
Contents............................................................................................................................vi
List of abbreviations.......................................................................................................viii
List of tables.....................................................................................................................ix
List of figures....................................................................................................................x
Chapter 1 Introduction.......................................................................................................1
1.1 Background......................................................................................................1
1.2 Study purpose..................................................................................................3
1.3 Specific aims and hypothesis.......................................................................................4
Chapter 2 Literature Review..............................................................................................5
2.1 Introduction of Parkinson’s disease.................................................................5
2.2 Motor learning ability in people with Parkinson’s disease..............................6
2.3 Methods to enhance motor learning.................................................................8
2.4 Mechanisms of aerobic exercise on motor learning.......................................11
2.5 Exercise protocol determination....................................................................13
2.6 Summary of review.......................................................................................15
Chapter 3 Methods..........................................................................................................16
3.1 Participants....................................................................................................16
3.2 Study procedure.............................................................................................16
3.3 Evaluation of implicit sequence learning……………………………...…...17
3.4 Exercise protocol...........................................................................................18
3.5 Outcome measures.........................................................................................19
3.6 Sample size estimation...................................................................................21
3.7 Data analysis……………………………………...……………...…...…….22
Chapter 4 Results.............................................................................................................24
4.1. Demographic and baseline characteristics of participants............................24
4.2 Performance of implicit sequence learning ...................................................24
4.3 Corticomotor excitability.............................................................................. 27
Chapter 5 Discussion.......................................................................................................30
Chapter 6 Conclusions.....................................................................................................38
Reference.........................................................................................................................39
Appendix 1. .....................................................................................................................48

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