Parkinson Disease
Conditions
Keywords
Whole Body Vibration, Proprioceptive Neuromuscular Facilitation Pattern, Rhythmic Based Training, Clinical Outcomes
Brief summary
This study has important clinical, academic, and practical relevance in neuromuscular rehabilitation. Clinically, it aims to identify effective and tolerable rehabilitation strategies for individuals with Parkinson's disease by comparing whole-body vibration therapy with proprioceptive neuromuscular facilitation (PNF) patterns combined with rhythmic-based training, thereby supporting evidence-based physiotherapy practice and improving patient adherence. Academically, it contributes to the limited literature on comparative effectiveness of these interventions and incorporates patient-centered outcomes such as exercise perception, which are often underreported. From a practical and societal perspective, identifying a more acceptable and effective approach may enhance long-term participation in rehabilitation, potentially slow disease progression, improve quality of life, and reduce the overall healthcare burden associated with Parkinson's disease.
Detailed description
Parkinson's disease is a progressive neurodegenerative disorder characterized by the loss of dopaminergic neurons in the substantia nigra, leading to motor symptoms such as tremor, rigidity, bradykinesia, and postural instability. It also presents with non-motor symptoms including cognitive decline, autonomic dysfunction, and reduced quality of life. The title of the present study focuses on evaluating the effectiveness of a combined rehabilitation approach integrating rhythmic-based training, whole-body vibration, and proprioceptive neuromuscular facilitation to improve gait, balance, and functional mobility in individuals with Parkinson's disease. The proposed protocols involve structured rhythmic auditory cueing exercises to enhance movement coordination and timing, whole-body vibration sessions aimed at improving neuromuscular activation and muscle strength, and proprioceptive neuromuscular facilitation techniques to facilitate motor control, flexibility, and functional movement patterns; these interventions are delivered in a progressive manner, tailored to patient tolerance and disease severity, with close monitoring to ensure safety and adherence. The study design is a randomized clinical trial with two experimental groups. The study duration is expected to span 8 to 12 weeks, allowing sufficient time for neuromuscular adaptations and observable functional improvements while maintaining feasibility and participant compliance. Outcome measures include standardized and validated tools such as the Unified Parkinson's Disease Rating Scale for assessing disease severity, the Timed Up and Go test for functional mobility, the 10-Meter Walk Test for gait speed, the Mini-BESTest for dynamic balance, and quality of life scales to evaluate overall patient well-being; these measures are recorded at baseline and post-intervention to determine the effectiveness of the combined rehabilitation protocol, providing comprehensive insight into motor performance, balance control, and functional independence in individuals with Parkinson's disease.
Interventions
OTHERWhole Body Vibration with Rhythmic Based Training
WBV will be applied during standing exercises using a vibration platform set at a frequency of 11 Hz and an amplitude of 3-6 mm (vertical oscillation). The intervention will be administered in intermittent cycles of 1 minute of vibration followed by 1 minute of rest, with a total cumulative exposure of 10-14 minutes per session (5-7 bouts). Concurrently, RBT will be delivered using an auditory metronome providing rhythmic cues synchronized with the exercise movements, with the tempo maintained between 110-130 beats per minute (BPM) to facilitate timing, coordination, and motor performance.
OTHERProprioceptive Neuromuscular Facilitation Pattern with Rhythm-Based Training
The patient will perform PNF Rhythmic Initiation (RI) D1 flexion and extension patterns for both upper and lower extremities in standing. The D1 flexion pattern involves shoulder extension, abduction, and external rotation progressing to flexion, adduction, and internal rotation, while the D1 extension pattern represents the reverse movement. The exercise will be progressed from passive to active-assisted and then to active-resistive movements to facilitate motor control and movement initiation. In addition, Rhythm-Based Training (RBT) will be applied using an auditory metronome to provide rhythmic cues synchronized with the active phase of the PNF movements, particularly during transitions between flexion and extension, with a consistent tempo of 110-130 beats per minute (BPM).
Sponsors
Lahore University of Biological and Applied Sciences
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
outcome assessor will be blind about participants allocation; this will ensure that their evaluations are objective and not influenced by knowledge of which treatment group participants belong to. Participants in both groups will be masked to the treatment of the other group by scheduling their sessions at different times.
Intervention model description
This study will use a parallel-group randomized clinical design, with participants randomly allocated into two intervention groups. Group A will receive Whole Body Vibration (WBV) combined with Rhythm-Based Training (RBT), where participants perform standing exercises such as weight shifting and mini-squats on a vibrating platform at 11 Hz frequency and 3-6 mm amplitude, applied in 1-minute bouts with 1-minute rest intervals for a total of 10-14 minutes. Rhythmic auditory cueing using a metronome set at 110-130 BPM will be provided concurrently or prior to enhance coordination and movement timing, with sessions conducted 2-3 times per week. Group B will receive Proprioceptive Neuromuscular Facilitation (PNF) using Rhythmic Initiation D1 flexion and extension patterns in standing, progressing from passive to active and resistive movements, structured in 1-minute work and rest intervals, with integrated rhythmic cueing at 110-130 BPM to improve motor control and functional performance.
Eligibility
Sex/Gender
ALL
Age
40 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Age between 40 and 60 years. * Patients of both genders (male and female). * Parkinson's disease severity at Hoehn and Yahr (H\&Y) stage 2 and 3. * Ability to walk independently for 6 minutes without an assistive device. * Score greater than 40 on the Berg Balance Scale.
Exclusion criteria
* Presence of impaired Cognition. * Significant Orthopedic and Musculoskeletal conditions that limit the adherence to exercise and WBV requirements. * Other medical conditions like thrombosis, cardiovascular conditions and medical implants that are contradicted for WBV.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Timed Up and Go (TUG) Test | [Time Frame: baseline, 8 weeks (post intervention), 12 weeks (follow up)] | The Timed Up and Go (TUG) test is a simple functional mobility assessment that measures the time taken (in seconds) to stand from a chair, walk 3 meters, turn, walk back, and sit down. It evaluates balance, gait, and functional mobility in a single task. Lower scores indicate better performance, with \<10 seconds considered normal, 10-20 seconds indicating mostly independent mobility, and \>20 seconds suggesting functional limitation. It is also commonly used as an indicator of fall risk, especially in neurological populations such as Parkinson's disease. |
| Unified Parkinson's Disease Rating Scale - Part III (UPDRS-III) | [Time Frame: baseline, 8 weeks (post intervention), 12 weeks (follow up)] | The Unified Parkinson's Disease Rating Scale (UPDRS-III) is a clinician-administered tool used to evaluate motor impairment in Parkinson's disease. It assesses key motor domains including tremor, rigidity, bradykinesia, posture, gait, and postural stability through direct observation. Each item is scored on a 0-4 scale, where 0 represents normal function and 4 indicates severe impairment, with a maximum total score of 132. Higher scores reflect greater motor dysfunction. The scale is widely used for monitoring disease severity and progression in both clinical and research settings. |
| Mini-Balance Evaluation Systems Test (Mini-BESTest) | [Time Frame: baseline, 8 weeks (post intervention), 12 weeks (follow up)] | The Mini-BESTest is a clinical balance assessment designed to evaluate dynamic balance and postural control across multiple systems, including anticipatory postural adjustments, reactive postural control, sensory orientation, and gait stability. It consists of 14 items scored from 0 to 2, with a total score ranging from 0 to 28, where higher scores indicate better balance performance. It is particularly sensitive in detecting balance impairments and fall risk in individuals with neurological conditions such as Parkinson's disease. |
| 10-Meter Walk Test (10MWT) | [Time Frame: baseline, 8 weeks (post intervention), 12 weeks (follow up)] | The 10-Meter Walk Test (10MWT) is a standardized measure of gait speed, where the time taken to walk a central 10-meter distance is recorded and converted into meters per second (m/s). It assesses functional walking ability and mobility performance. The test can be performed at a comfortable or fast pace to evaluate functional capacity. It is widely used in Parkinson's disease to monitor gait impairments and response to rehabilitation, as gait speed is a strong indicator of overall functional status. |
Countries
Pakistan
Outcome results
None listed