Effects of Virtual Reality Versus Motor Imagery Versus Routine Physical Therapy in Patients With Parkinson's Disease.

Study Overview
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Brief Summary
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The aim of this study is to investigate the effects of VR and MI techniques in addition to routine physical therapy on motor skills, balance and ADL in patients with Parkinson's disease.

Detailed Description
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Parkinson's disease is one of the most common, insidious neurological disorders with major motor symptoms, including bradykinesia, resting tremors, rigidity, and postural disorders. Virtual reality and motor imagery are among the more innovative techniques for rehabilitation of patients with Parkinson's disease that promote motor learning through both explicit and implicit processes.This study is unique in that it examines the effects of VR versus MI on motor skills, balance, and daily living activities in individuals with Parkinson's disease

Official Title
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Effects of Virtual Reality Versus Motor Imagery Versus Routine Physical Therapy in Patients With Parkinson's Disease: A Randomised Controlled Trial

Conditions
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Parkinson Disease

Intervention / Treatment
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* Other: VR with Routine physical therapy and Virtual reality
* Other: Motor Imagery with Routine physical therapy
* Other: Routine physical therapy


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Idiopathic Parkinson's disease Modified Hoehn and Yahr Scale(H&Y stages I to III) Between the ages of 50 and 80 years of both genders Independent in transfers A score equal to or greater than 24 on the Mini-Mental State Examination (MMSE), and Previous lack of participation in balance or motor training. Exclusion Criteria: History of any neurological conditions such as stroke, multiple sclerosis, epilepsy other than Parkinson's disease, History of orthopedic issues such as pain, fracture, or lower limb pathology, History of visual abnormalities, History of any chronic or cardiovascular pathology that can interfere with the transfer procedure or can affect the training sessions, The participants having severe dyskinesia or on-off phases, Previous history of surgery for PD, History of virtual games used for treatment in the past three months, and Virtual game phobia.

Ages Eligible for Study
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Minimum Age: 50 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Virtual Reality with Routine Physical Therapy<br>The duration of the VR will be from 10 to 15 minutes during each session and Routine Physical Therapy for 40 minutes which consists of warming-up, stretching, strengthening and active exercises for relaxation, coordination exercises for limbs, trunk, neck, and gait training) | Other: VR with Routine physical therapy and Virtual reality<br>* VR group will be treated with virtual reality for 15 to 20 minutes along with routine physical therapy for 40 minutes session 3 days/week for 12 weeks<br>* Other names: Rehabilitation following VR with Routine physical therapy treatment;|
| Experimental: Motor imagery technique with Routine Physical Therapy<br>Motor Imagery techniques will be given for 5 to 10 minutes along with routine physical therapy for 40 minutes which consists of warming-up, stretching, strengthening and active exercises for relaxation, coordination exercises for limbs, trunk, neck, and gait training) | Other: Motor Imagery with Routine physical therapy<br>* MI group will be treated with virtual reality for 15 to 20 minutes along with routine physical therapy for 40 minutes session 3 days/week for 12 weeks<br>* Other names: Rehabilitation following MI with Routine physical therapy treatment;|
| Experimental: Routine Physical Therapy<br>Only routine physical therapy will be given (including warming-up, stretching, strengthening and active exercises for relaxation, coordination exercises for limbs, trunk, neck, and gait training) | Other: Routine physical therapy<br>* 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<br>* Other names: Rehabilitation following Routine physical therapy treatment;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Unified Parkinson's disease Rating Scale Part II | This is a subjective instrument that is widely used in clinical settings for patients with Parkinson's disease. This scale comprises 31 elements, which are divided into three sub-scales: Sub-scale II comprises the evaluation of activities in daily living. A possible maximum of 199 points can be scored on this scale. A score of 199 refers to complete disability and 0 refers to the absence of disability . | 3 months | 
| Unified Parkinson's disease Rating Scale Part III | This is a subjective instrument that is widely used in clinical settings for patients with Parkinson's disease. This scale comprises 31 elements, which are divided into three sub-scales and sub-scale III evaluates the motor system. A possible maximum of 199 points can be scored on this scale. A score of 199 refers to complete disability and 0 refers to the absence of disability | 3 months | 
| Berg Balance Scale (BBS) | The scale has been established as the most widely used assessment tool in clinical settings to identify changes in balance performance. A score of less than 45 is considered a limit for the risk of falling, while a score of 56 relates to functional balance | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Activities-specific Balance Confidence Scale (ABC): | This scale is used as a predictor of falls in patients with neurological deficits. Patients are rated from 0% to 100%, with 0% interpreted as not at all safe and 100% as completely safe | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Parkinson, Virtual Reality, Motor Imagery, Routine Physical Therapy