Effects of Virtual Reality with Motor Imagery Techniques in Patients with Parkinson’s Disease: Study Protocol for a Randomized Controlled Trial

Abstract

<b><i>Background:</i></b> Parkinson’s disease (PD) is one of the most common neurological disorders, of insidious onset, with major motor symptomatology including bradykinesia, rest tremor, rigidity, and postural disturbances. Virtual reality (VR) and motor imagery (MI) are among the more innovative techniques for the rehabilitation of patients with PD which promote motor learning both through explicit and implicit processes. This study is unique in that it will examine the combined effects of VR and MI on motor function, balance and activities of daily living (ADLs) in patients with PD. <b><i>Objective:</i></b> The aim of this work is to investigate the effects of VR with MI techniques in addition to routine physical therapy on motor function, balance, and ADLs in patients with PD. <b><i>Methods:</i></b> This is a two-armed parallel design, single-blinded (assessor blinded), single-centered, randomized controlled trial, and the study protocol is based on SPIRIT guidelines. Thirty-four patients with PD (Modified Hoehn and Yahr stages I–III) will be randomly allocated with a 1:1 ratio into Group A (control group) and Group B (treatment group). Group A will be given routine physical therapy in 40-min sessions and 20 min of walking and cycling with a short period of rest, every alternate day (3 days per week) for 12 weeks, while for Group B routine physical therapy protocols along with VR and MI will be used in 60-min sessions, every alternate day (3 days per week) for 12 weeks. The primary outcome measures are as follows: (i) the Unified PD Rating Scale (UPDRS; part III), (ii) the Berg Balance Scale (BBS), and the Activities-Specific Balance Confidence Scale (ABC). The secondary outcome measure is the UPDRS (part II). Assessments will be recorded at baseline, the sixth and twelfth weeks of therapy, and 1 month after the discontinuation of therapy. <b><i>Clinical Study Registration:</i></b> This randomized controlled prospective study was registered with the Iranian Registry of clinical trials (IRCT20200221046567N1) on April 1, 2020 (https://www.irct.ir/trial/46073).

Psychometric Properties of the Urdu Translation of Berg Balance Scale in People with Parkinson’s Disease

“…Parkinson’s disease (PD) is a pathological condition characterised by a variety of motor as well as non-motor problems. Resting tremors, bradykinesia, rigidity, and postural instability are the main problems associated with motor symptomatology [ 1 ]. Its onset is more prevalent at 65 years of age or above and is a cause of emotional as well as financial stress on caregivers [ 2 ].…”

“…The total score ranges from 0 to 56 with a higher score indicating less balance impairment. A score less than 45 indicates the risk of falling, whereas a score of 56 shows good functional balance [ 1 ]. According to other criteria, patients with restricted mobility or who are wheel-chair bound, people who require assistance during the gait, and those independent in gait fall within the range of 0–20, 21–40, and 41–56 BBS score, respectively [ 7 ].…”

The combined effects of virtual reality with motor imagery techniques in patients with Parkinson’s disease

“…To date, no study has been reported in the literature that has examined the combined effects of VR and MI combined with routine PT in PD. A well-designed protocol (16) was used for these patients based on the clinical manifestations of PD in different clinical stages. An interesting aspect of the VR and MI-based interventions used in this case report was the cognitive demands during training that were reported by the clients.…”

A Randomized Controlled Trial of Motor Imagery Combined with Virtual Reality Techniques in Patients with Parkinson’s Disease

“…Parkinson’s disease (PD) is the second most common chronic neurodegenerative condition, characterized by bradykinesia, stiffness, resting tremors, and postural instability, as well as a variety of motor and non-motor symptoms [ 1 , 2 ]. The Parkinson’s Foundation reports that Parkinson’s disease is a slowly developing disease that affects nearly one million Americans and more than 10 million individuals worldwide [ 3 , 4 ].…”

“…There is evidence that explicit and implicit learning occur concurrently, and that the two may be employed in tandem to increase or complement each other’s impact. The MI is also supposed to support the VR-developed learning process [ 1 ]. As a result, it is claimed that MI can promote broad and consolidative learning in PD patients.…”