The rationale for motor learning in Parkinson's disease

Parkinson's disease (PD) is a chronic progressive disorder mainly affecting the motor system. PD is only partially controlled by symptomatic dopaminergic treatment. Therefore, motor rehabilitation can be used in PD to reduce complications and to train patients in the use of compensatory movement strategies. Rehabilitative practice is largely dependent on the efficiency of motor learning, i.e. the acquisition of new abilities or the adaptation of pre-existing ones. Although patients with PD are able to improve their motor performance through practice, the amount and persistence of clinical benefit are uncertain. Both "implicit" (procedural) and "explicit" (declarative) features of motor learning have been extensively investigated in patients with PD using neuropsychological testing, serial reaction time paradigms, and analysis of reaching movements. Evidence from these studies suggests an early impairment of "explicit" learning in PD, while "implicit" learning is relatively preserved. The consolidation of learned motor tasks is defective in PD and the mechanisms of motor learning seem to be independent from dopamine-replacement therapy. The knowledge of motor learning in PD is critical in designing more effective rehabilitative protocols.