Trunk Control Exercises and Mirror Therapy on Balance and Posture in Parkinson's Disease

Official title

Effects of Trunk Control Exercises and Mirror Therapy on Balance and Posture in Patients With Parkinson's Disease

Overview

Parkinson's disease (PD) is movement disorder of the nervous system that worsens over time. As nerve cells (neurons) in parts of the brain weaken or are damaged or die, people may begin to notice problems with movement, tremor, stiffness in the limbs or the trunk of the body, or impaired balance. As these symptoms become more obvious, people may have difficulty walking, talking, or completing other simple tasks. Not everyone with one or more of these symptoms has PD, as the symptoms appear in other diseases as well. Both non-modifiable (age, gender) and modifiable risk factors such as occupation, exposure to pesticides, and depression have an association with PD. Several studies have suggested that Parkinson disease is more common in men. The MT mechanism is based on the concept of visual illusion. The movement of the non-paretic part in front of the mirror (reflective side) is perceived as that of the paretic body part (hidden beside the mirror). MT allows an individual to have an experience of normal movement, even for the severely paralyzed limb. In addition, wherever other rehabilitation methods fail to induce normal movements without any compensation, MT may act as a foundation step for further motor therapy. The perception of movement illusion, a neuropsychological phenomenon may induce neural activation of the lesioned brain and enhance associated motor recovery. Therefore the aim of this study is to compare the effects of truck control exercise program and mirror therapy on balance and postural instability in patients with Parkinson's disease.

Detailed description

Parkinson's disease (PD) is movement disorder of the nervous system that worsens over time. As nerve cells (neurons) in parts of the brain weaken or are damaged or die, people may begin to notice problems with movement, tremor, stiffness in the limbs or the trunk of the body, or impaired balance. As these symptoms become more obvious, people may have difficulty walking, talking, or completing other simple tasks. Not everyone with one or more of these symptoms has PD, as the symptoms appear in other diseases as well. Both non-modifiable (age, gender) and modifiable risk factors such as occupation, exposure to pesticides, and depression have an association with PD. Several studies have suggested that Parkinson disease is more common in men. The MT mechanism is based on the concept of visual illusion. The movement of the non-paretic part in front of the mirror (reflective side) is perceived as that of the paretic body part (hidden beside the mirror). MT allows an individual to have an experience of normal movement, even for the severely paralyzed limb. In addition, wherever other rehabilitation methods fail to induce normal movements without any compensation, MT may act as a foundation step for further motor therapy. The perception of movement illusion, a neuropsychological phenomenon may induce neural activation of the lesioned brain and enhance associated motor recovery. Therefore the aim of this study is to compare the effects of truck control exercise program and mirror therapy on balance and postural instability in patients with Parkinson's disease.

Screening: Patients will be screened to meet inclusion criteria. The consent form will be taken from patients then patients will be randomly allocated into two groups (28 in each group). Patients fulfilling the inclusion criteria will be randomly divided into experimental and control groups using the computer software. The study will be single-blinded. The assessor will be unaware of the treatment given to both groups. Data will be collected at baseline and then at the end of the sixth week. Before applying intervention, Berg Balance scale will be used to measure level of balance and goniometer will be used to measure two-dimensional angular deviations between the pelvis and the upper part of the trunk.

Interventions

• Other Trunk control exercise
  The participants will complete balance exercises which targeted their feedforward along with feedback postural reflexes. The exercise program will include three different groups of tasks: self-destabilizing movements such as rolling on the toes and bouncing a ball while walking as well as external destabilization tasks like balancing on foam surfaces and therapist-performed perturbations and coordinated arm movements during walking. The patients will undergo ten specific movements per session an
• Other Mirror therapy
  In this, each patient will be instructed to keep the affected limb in static position. The limb will be in the position of hip 90°, knee 90°, and ankle 90° for the short-sitting posture and in the position of hip 90°, knee 0°, and ankle neutral in the long-sitting posture. The position of the limb was ensured from time to time. The repetition will be modulated to complete the maximum time of each session. Weight bearing in standing (extended knee) 2-3 minutes, Weight bearing in standing on incli

Primary outcome measures

• Berg Balance Scale: [Time frame: 12 weeks]

Secondary outcome measures (1)

• Unified Parkinson's Disease Rating Scale (UPDRS-PG): [Time frame: 12 weeks]

Eligibility criteria

Inclusion criteria

• • 50-70 age(Bomasang-Layno et al., 2015)

• Both genders (Bomasang-Layno et al., 2015)
• Patient with grade 1,2,3 Parkinsonism (according to Hoehn and Yahr scale)
• Patient taking fixed dose of medicines
• No cognitive impairment (according to Mini-Mental scale 24-30 scoring) (Capecci et al., 2014)
• The patient was able to get out of chairs and beds without assistance (Hoffmann et al., 2016).
• Individuals without significant dyskinesias or "on-off" periods.(Lötzke et al., 2015)

Exclusion criteria

• • Patient having any recent episode of epilepsy(Bomasang-Layno et al., 2015)

• Patient has had any recent trauma. (Hong et al., 2009)
• Individuals free from chronic diseases such as unstable cardiovascular disease that could compromise their safety during training or testing (Hoffmann et al., 2016).

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Double blind

Primary purpose

Treatment

Study locations

Pakistan · 1 center

• Nimra Nadeem — Lahore

Publications

• Lopez-Liria R, Vega-Tirado S, Valverde-Martinez MA, Calvache-Mateo A, Martinez-Martinez AM, Rocamora-Perez P. Efficacy of Specific Trunk Exercises in the Balance Dysfunction of Patients with Parkinson's Disease: A Systematic Review and Meta-Analysis. Sensors (Basel). 2023 Feb 6;23(4):1817. doi: 10.3390/s23041817. PMID 36850413
• Hubble RP, Silburn PA, Naughton GA, Cole MH. Trunk Exercises Improve Balance in Parkinson Disease: A Phase II Randomized Controlled Trial. J Neurol Phys Ther. 2019 Apr;43(2):96-105. doi: 10.1097/NPT.0000000000000258. PMID 30883497
• Aarsland D, Batzu L, Halliday GM, Geurtsen GJ, Ballard C, Ray Chaudhuri K, Weintraub D. Parkinson disease-associated cognitive impairment. Nat Rev Dis Primers. 2021 Jul 1;7(1):47. doi: 10.1038/s41572-021-00280-3. PMID 34210995
• Bonassi G, Pelosin E, Ogliastro C, Cerulli C, Abbruzzese G, Avanzino L. Mirror Visual Feedback to Improve Bradykinesia in Parkinson's Disease. Neural Plast. 2016;2016:8764238. doi: 10.1155/2016/8764238. Epub 2016 Aug 1. PMID 27563470
• Gandolfi M, Tinazzi M, Magrinelli F, Busselli G, Dimitrova E, Polo N, Manganotti P, Fasano A, Smania N, Geroin C. Four-week trunk-specific exercise program decreases forward trunk flexion in Parkinson's disease: A single-blinded, randomized controlled trial. Parkinsonism Relat Disord. 2019 Jul;64:268-274. doi: 10.1016/j.parkreldis.2019.05.006. Epub 2019 May 3. PMID 31097299

Identifiers

NCT: NCT07610031 · REC-UOL-/343/08/24

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗