The use of brain-machine interface, motor imagery, and action observation in the rehabilitation of individuals with Parkinson's disease: A protocol study for a randomized clinical trial

Abstract

Background: Parkinson's disease (PD) is a neurodegenerative condition that impacts motor planning and control of the upper limbs (UL) and leads to cognitive impairments. Rehabilitation approaches, including motor imagery (MI) and action observation (AO), along with the use of brain-machine interfaces (BMI), are essential in the PD population to enhance neuroplasticity and mitigate symptoms.

Objective: To provide a description of a rehabilitation protocol for evaluating the effects of isolated and combined applications of MI and action observation (AO), along with BMI, on upper limb (UL) motor changes and cognitive function in PD.

Methods: This study provides a detailed protocol for a single-blinded, randomized clinical trial. After selection, participants will be randomly assigned to one of five experimental groups. Each participant will be assessed at three points: pre-intervention, post-intervention, and at a follow-up four weeks after the intervention ends. The intervention consists of 10 sessions, each lasting approximately 60 minutes.

Expected results: The primary outcome expected is an improvement in the Test d'Évaluation des Membres Supérieurs de Personnes Âgées score, accompanied by a reduction in task execution time. Secondary outcomes include motor symptoms in the upper limbs, assessed via the Unified Parkinson's Disease Rating Scale - Part III and the 9-Hole Peg Test; cognitive function, assessed with the PD Cognitive Rating Scale; and occupational performance, assessed with the Canadian Occupational Performance Measure.

Discussion: This study protocol is notable for its intensive daily sessions. Both MI and AO are low-cost, enabling personalized interventions that physiotherapists and occupational therapists can readily replicate in practice. While BMI use does require professionals to acquire an exoskeleton, the protocol ensures the distinctiveness of the interventions and, to our knowledge, is the first to involve individuals with PD.

Trial registration: ClinicalTrials.gov NCT05696925.

Fig 1. SPIRIT schedule of enrolment, interventions, and assessments of the study.

COPM, Canadian Occupational Performance Measure; H&Y, Escala Hoehn e Yahr; KVIQ-10, Kinesthetic and Visual Imagery Questionnaire; MoCA, Montreal Cognitive Assessment; PD-CRS, Parkinson’s disease-cognitive rating scale; t, time; TEMPA, Test D’évaluation Des Membres Supérieurs Des Personnes Âgées; UPDRS, Unified Parkinson’s Disease Rating Scale; 9HPT, Nine Hole Peg Test.

Fig 2. Flowchart of participant distribution throughout each stage of the study.

AO, action observation; BMI, brain machine interface; AE, action execution; EG, experimental group; MI, motor imagery.

Fig 3. BMI equipment system.

Fig 4. Sequence of applicability of interventions.

AO, action observation; BMI, brain machine interface; AE, action execution; EG, experimental group; MI, motor imagery.

Fig 5. Description of the intervention as an example of personal care activity - organize the week’s medication.

D, dominant; DUL, dominant upper limb; ND, non-dominant; NDUL, non-dominant upper limb.

Fig 6. Description of the intervention as an example of productivity activity - hang the clothes on the clothesline.

D, dominant; DUL, dominant upper limb; ND, non-dominant; NDUL, non-dominant upper limb.

Fig 7. Description of the intervention as an example of a leisure activity - shuffle and deal the cards.

D, dominant; DUL, dominant upper limb; ND, non-dominant; NDUL, non-dominant upper limb.