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

NCT07610031 | Recruiting DMC

• 1 other identifier: REC-UOL-/343/08/24
• Study Type: interventional
• Target: 36
• Locations: 1 country
• Sites: 1

Brief Summary

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.

Conditions

Parkinson s Disease

Outcome Measures

Primary Outcomes (1)

• Berg Balance Scale:

  Using a series of pre-established exercises, the Berg Balance Scale (BBS) evaluates a patient's objective ability-or lack thereof-to maintain balance (Lima et al., 2018). The fourteen things on the list are assessed on a five-point ordinal scale, with 0 being the lowest degree of function and 4 the greatest level. Completing the list takes approximately twenty minutes. It excludes the gait analysis. (Louie \& Eng, 2018).

  12 weeks

Secondary Outcomes (1)

• Unified Parkinson's Disease Rating Scale (UPDRS-PG):

  12 weeks

Study Arms (2)

Trunk control exercise

EXPERIMENTAL

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 and medical staff raised the exercise difficulty level as they made improvement. The principal investigator will provide verbal instruction together with physical help if required.

Other: Trunk control exercise; Other: Mirror therapy

Mirror therapy

EXPERIMENTAL

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 inclined wedge 2-3 minutes. Movements using associated reactions 10 repetitions, Knee flexion control in prone position 10 repetitions, Active-assistive movement using activities (medicinal ball, rocker board, pedocycle, jogger) for hip (flexion), knee (flexion-extension) and ankle (ankle dorsi flexion-plantar flexion) in sitting position 10 repetitions for each.

Other: Trunk control exercise; Other: Mirror therapy

Interventions

Trunk control exercise OTHER

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 and medical staff raised the exercise difficulty level as they made improvement. The principal investigator will provide verbal instruction together with physical help if required.

Mirror therapy; Trunk control exercise

Mirror therapy OTHER

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 inclined wedge 2-3 minutes. Movements using associated reactions 10 repetitions, Knee flexion control in prone position 10 repetitions, Active-assistive movement using activities (medicinal ball, rocker board, pedocycle, jogger) for hip (flexion), knee (flexion-extension) and ankle (ankle dorsi flexion-plantar flexion) in sitting position 10 repetitions for each.

Mirror therapy; Trunk control exercise

Eligibility Criteria

• Age: 50 Years - 70 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• 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)

You may not qualify if:

• 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).

Sponsors & Collaborators

• University of Lahore: lead

Study Sites (1)

Nimra Nadeem

Lahore, Punjab Province, 54000, Pakistan

RECRUITING

Related Publications (5)

• 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 RESULT

• 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 RESULT

• 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 RESULT

• 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 RESULT

• 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 RESULT

MeSH Terms

Conditions

Parkinson Disease

Interventions

Mirror Movement Therapy

Condition Hierarchy (Ancestors)

Parkinsonian Disorders; Basal Ganglia Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases

Intervention Hierarchy (Ancestors)

Physical Therapy Modalities; Rehabilitation; Therapeutics

Study Officials

• Nimra Nadeem, MS (NMPT)

  University of Lahore

  PRINCIPAL INVESTIGATOR

• Hafiza Sana Ashraf, MS-MSK

  University of Lahore

  PRINCIPAL INVESTIGATOR

Central Study Contacts

Ishaq Ahmed, PHD

CONTACT

0334 4066 463; ishaq.ahmed@uipt.uol.edu.pk

Ashfaq Ahmad, PHD

CONTACT

03009449192; ashfaq.ahmad@uipt.uol.edu.pk

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: DOUBLE
• Who Masked: PARTICIPANT, OUTCOMES ASSESSOR
• Masking Details: Double (Outcomes Assessor and Participants) The study will be single and assessor-blinded. Participants will be masked about other groups, but they will know what treatment they will be receiving or what exercises they will be doing..
• Purpose: TREATMENT
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: September 8, 2025
• First Posted: May 27, 2026
• Study Start: December 22, 2024
• Primary Completion: June 15, 2026
• Study Completion: June 20, 2026
• Last Updated: May 27, 2026

Record last verified: 2025-12

Data Sharing

• IPD Sharing: Will not share

Locations

PA (1)