Gait physiotherapy with motor imagery in people with Parkinson's disease: a protocol for randomized control GAITimagery trial

Abstract

Introduction: According to people with Parkinson's disease (PD), gait impairments are the most disabling motor symptoms of PD. Recently, motor imagery (MI) has gained notoriety as a gait training technique due to the flexibility of its use, however, it has not been demonstrated that causes a superior effect when included in physiotherapy. This study aims to determine if gait training combined with MI has a greater effect on the gait of people with PD than just gait training.

Methods: The GAITimagery is designed as a double-blind, randomized control trial, including a convenience sample in 2 parallel groups (1:1) with two interventions of 2 sessions per week during 6-week and 8-week follow-up. The initial recruitment will be 88 participants with idiopathic PD and unimpaired cognition state, who will be randomly divided into two groups: GAITimagery (GiG) or the active control Gait group (GaG). Both will perform the same gait exercises but only GiG will include MI training. Gait speed is the primary outcome, while Maximum gait speed (m/s) and Gait speed variability are the secondary results. The tertiary outcomes are related to Quality of life, Daily life activities, Freezing of gait, Balance, Mobility, and Gait performance measures to psychometrics and biomechanics instruments. All results will be measured at baseline (t0), post-training (t1), and follow-up assessment (t2) 8 weeks after finished physiotherapy programs.

Discussion: The GAITimagery program standardizes the application of MI exercises related to the improvement of parkinsonian gait at the same time that monitoring the vividness referred by the participants session by session. The effectiveness of this MI-exclusive program includes subjective and objective measurement tools to detect minimal changes after training. This still-to-be-finish study will support the therapeutic decisions on whether or not to allocate session time to imagery exercises depending on the effect size achieved and the comparison with a control gait training.

Keywords: Parkinson’s disease; action observation; biomechanic; gait; motor imagery; physical therapy; physiotherapy; quality of life.

Figure 1

Trial design and participants flow. Flow of the study intervention and assessment.

Figure 2

Organization of the GAITimagery and control gait program session. Both programs have the same structure with the exception of the Relaxation and Motor imagery section, which will be only performed in the GAITimagery program. AO, action observation. MI, motor imagery.

Figure 3

Vividness control of motor imagery exercises. The items aims to control whether the GAITimagery program participants are being able to carry out the motor imagery exercises effectively.

Figure 4

Biomechanical model and anatomical placement of motion capture markers. (A) Dynamometric platform used in the biomechanical gait assessment. (B) Instrumentation of Inertial Sensor Units measure, which will be attached by elastic straps provided by the manufacturer. Each sensor must be placed at the following zones: (B.1) Lumbar, located just below the spinosa of the lumbar vertebra 5. (B.2) Thighs, located at the lower limit of the upper third of the thigh, on its lateral surface. It is considered as the total measurement of the thigh from the greater trochanter to the interarticular line. (B.3) Legs, placed at the midpoint of the leg measured from the interarticular line to the medial malleolus. The sensor is positioned just medial to the tibial border. (B.4) Feet, positioned on the dorsum of the foot, four centimeters from the intersection of the inter-malleolar line, above a line projected toward the fourth toe.