Mental Practice Combined With Physical Practice to Improve the Gait Performance of People With Parkinson's Disease
Condition: Parkinson Disease
MeSH terms: Parkinson Disease
Study type: Interventional

Summary: 
      Among the impairments associated to Parkinson's disease, gait disturbance is one of which
      that has the most negative impact on the independence in daily living activities and quality
      of life of people living with Parkinson's disease. Despite the considerable amount of
      research, we have no consensus about the most efficient physiotherapeutic approach to improve
      the gait disturbance. Mental practice is considered an efficient strategy to improve the
      motor performance in healthy individuals and people with stroke. However, there is scarce
      evidence about its therapeutic results to improve the gait performance in people living with
      Parkinson's disease. Thus, the aim of this study is to investigate the effects of gait mental
      practice associated to physical practice to improve the gait performance in people living
      with Parkinson's disease.
    

Detailed description: 
      Background: Among the impairments associated to Parkinson's disease, the gait disturbance is
      one of which that has the most negative impact on the independence in daily living activities
      and quality of life of people living with Parkinson's disease. Despite the considerable
      amount of research, we have no consensus about the most efficient physiotherapeutic approach
      to improve the gait disturbance. Mental practice is considered an efficient strategy to
      improve the motor performance in healthy individuals and people with stroke. However, there
      is scarce evidence about its therapeutic results to improve the gait performance in people
      living with Parkinson's disease.

      Objectives: To investigate the effects of mental gait practice associated with physical
      practice to improve the gait performance of people living with Parkinson's disease.

      Design: Parallel, prospective, double-blind, multicentre randomized clinical trial.

      Setting: Brazilian Parkinson Association.

      Participants: Twenty-two people living with Parkinson's disease in stages 2-3 of disease
      evolution according to Hoehn and Yahr Classification.

      Interventions: The participants will be randomly allocated in an experimental group and a
      control group. Both groups will perform 10 individual training sessions, two times per week,
      for five weeks. The training sessions consist of four blocks of mental practice intercalated
      with four blocks of physical practice of gait under different conditions. The only difference
      between the groups will be the content of mental practice blocks: the experimental group will
      perform mental practice of gait while the control group performs non-gait mental practice.

      Randomization: Participants will be randomized by ClinStat software into one of two groups:
      Experimental Group (EG), which will perform gait mental practice; and Control Group (CG),
      which will perform the non-gait mental practice.

      Statistical analysis: The training effects for each primary and secondary outcome measure
      will be analyzed for the two training conditions (i.e., control and experimental) at the four
      assessment time points (i.e., pre-intervention, 7 days post-completion and at 30 and 60-day
      follow-up) using a mixed-design ANOVA with training as the between-group factor and the
      assessment time point as the within-group factor. The effect sizes (ES) will be calculated
      for all comparisons at alpha = 0.05. A Tukey HSD post-hoc test will be used for multiple
      comparisons and p-values below 5 % will be considered as statistically significant.
    

Intervention name(s): Experimental training; Control training
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Each block of MP consists of 5 mental walking attempts with 10 imagined steps. Participants, seated comfortably, eyes closed, will be asked to imagine themselves walking as of a first-person perspective, without any overt physical movement, in four different conditions: habitual speed, as fast as possible, overcoming obstacles and memorizing a name of a specific medication.
Each block of PP consists of 5 physical walking attempts, with 10 steps. Participants will be asked to walk in 4 different conditions: habitual speed,as fast as possible, overcoming obstacles and memorizing a name of a specific medication.; Each block of MP consists of 5 mental walking attempts with 10 imagined steps. Participants, seated comfortably, eyes closed, will be asked to imagine themselves seated appreciating a beautiful landscape as of a first-person perspective, without any overt physical movement, in four different contexts: in a carriage, in a hot air balloon, in a boat and in a zepelin.
Each block of PP consists of 5 physical walking attempts, with 10 steps. Participants will be asked to walk in 4 different conditions: habitual speed,as fast as possible, overcoming obstacles and memorizing a name of a specific medication.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Randomized clinical trial; Parkinson's disease; Mental practice; Gait