Effects of Exercise With Visual Feedback in Parkinson's Disease

Effects of Visual Indicator Exercises for the Trunk and Lower Extremities on Activity and Participation in Parkinson's Disease

Patients with Parkinson's disease who apply to the Hasan Kalyoncu University Application and Research Center and meet the inclusion criteria will be included in the study. The included participants will be randomly assigned into either the intervention group or the control group using a sealed-envelope method. Both groups will undergo a standard exercise program, consisting of posture, strengthening, and balance training, under the supervision of a physiotherapist for 8 weeks, 3 days per week. In addition to this, the intervention group will receive an additional exercise program incorporating visual feedback using a laser pointer, targeting the trunk and lower extremities, also under the supervision of a physiotherapist for 8 weeks, 3 days per week.

Study Overview

• Status: Recruiting
• Conditions: Parkinson Disease; Exercise Training; Balance Impairment; Postural Control
• Intervention / Treatment: Other: Control Group; Other: Visual Feedback Exercise Group

Detailed Description

This study aims to investigate the effects of visual feedback exercise training focused on balance, postural control, and lower extremity mobility using a laser pointer, in addition to standard rehabilitation, on activity and participation in individuals with Parkinson's disease.

Hypotheses:

H1: Incorporating visual feedback-based trunk and lower extremity exercises using a laser pointer into standard rehabilitation improves body structure and function in individuals with Parkinson's disease.

H2: Incorporating visual feedback-based trunk and lower extremity exercises using a laser pointer into standard rehabilitation enhances activity and participation in individuals with Parkinson's disease.

• Study Type: Interventional
• Enrollment (Estimated): 32
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Büşra Akıncı, MSc; Phone Number: +90 (541) 976 55 83; Email: busra.tufekci@hotmail.com
• Study Contact Backup: Name: Günseli Usgu, Assoc. Prof.; Email: gunseli.usgu@hku.edu.tr

Study Locations

• Turkey (Türkiye)
  • Şahinbey
    • Gaziantep, Şahinbey, Turkey (Türkiye), 27000
      • Recruiting
      • Hasan Kalyoncu University
      • Contact: Günseli Usgu, Assoc. Prof.; Phone Number: +90 ( 342 ) 211 80 81; Email: info@hku.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria

• Individuals diagnosed with idiopathic Parkinson's disease
• Disease severity classified as stage 1 to 3 according to the Modified Hoehn and Yahr Scale
• Patients receiving oral antiparkinsonian treatment only

Exclusion Critera

• Presence of musculoskeletal, cardiovascular, or vestibular disorders that may interfere with the completion of the assessments or treatment protocol
• Presence of additional neurological or psychiatric disorders other than Parkinson's disease
• Presence of visual impairment insufficient to perceive visual feedback

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: standard exercise program; Participants in the standard exercise group will receive a physiotherapist-supervised exercise program, performed three times per week for a total duration of eight weeks.	Other: Control Group; The exercises will start with 6-8 repetitions and will increase by 2 repetitions each week. Cervical Region: Cervical rotation, lateral flexion, chin-tuck exercises Upper Extremity: Shoulder joint range of motion exercises with a wand, scapular adduction, shoulder retraction Lower Extremity: Bridge exercise, hip flexion, extension, abduction exercises, knee extension exercises, ankle dorsiflexion - plantar flexion exercises Balance Exercises: Perturbation exercises with eyes open and eyes closed on a hard surface, perturbation exercises with eyes open and eyes closed on a soft surface, maintaining a tandem stance Ambulation: Walking training on a treadmill with a Modified Borg Scale of level 3-4. Walking training will begin with 6 minutes in the first week and will increase by 1 minute each week.
Experimental: standard exercise program and visual feedback-based exercise program; Participants in the standard exercise program and visual feedback-based exercise program group will receive a physiotherapist-supervised exercise program, performed three times per week for eight weeks.	Other: Control Group; The exercises will start with 6-8 repetitions and will increase by 2 repetitions each week. Cervical Region: Cervical rotation, lateral flexion, chin-tuck exercises Upper Extremity: Shoulder joint range of motion exercises with a wand, scapular adduction, shoulder retraction Lower Extremity: Bridge exercise, hip flexion, extension, abduction exercises, knee extension exercises, ankle dorsiflexion - plantar flexion exercises Balance Exercises: Perturbation exercises with eyes open and eyes closed on a hard surface, perturbation exercises with eyes open and eyes closed on a soft surface, maintaining a tandem stance Ambulation: Walking training on a treadmill with a Modified Borg Scale of level 3-4. Walking training will begin with 6 minutes in the first week and will increase by 1 minute each week.; Other: Visual Feedback Exercise Group; The visual feedback exercise will be performed using a wearable laser pointer attached to the trunk and lower extremities, along with a visual tracking screen. The exercise duration is 20 minutes. The laser placed on the trunk will be used in various exercises, including maintaining stability in a seated position, on a Swiss ball, while standing, during different movements, and on various surfaces. Additionally, trunk control exercises will involve rotational, vertical-horizontal, and circular movements. Exercises targeting trunk control in a crawling position will also be included. For the lower extremities, the program will focus on ankle dorsiflexion, hip abduction and extension, and knee extension. All exercises will be progressively individualized on a weekly basis.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Center of Pressure Elliptical Area	Postural control will be assessed using the Gyko wearable device. After the wearable vest is properly fitted, the participant will be asked to maintain balance for 30 seconds under four conditions: firm surface with eyes open, firm surface with eyes closed, soft surface with eyes open, and soft surface with eyes closed. The elliptical area of center of pressure displacement (mm²) obtained from the Gyko system will be recorded for each condition and used as the primary outcome measure.	up to 8 weeks
Berg Balance Scale	The Berg Balance Scale is used to assess functional balance. It evaluates both dynamic and static balance through 14 tasks related to different positions, postural changes, and mobility. Each task is scored between 0 and 4 based on the individual's ability to perform the task independently, for a certain period, or over a specific distance (0: unable to perform, 4: normal performance). The highest possible score on the scale is 56, and a higher score indicates greater independence.	up to 8 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
L Test	The L Test is a functional mobility assessment. The participant starts from a seated position in a chair without armrests and, upon command, walks at a comfortable speed to a marked 3-meter point, turns right, continues walking for 7 meters, turns around, and returns to sit in the chair. The total time to complete the test (seconds) will be recorded.	up to 8 weeks
Unified Parkinson's Disease Rating Scale	The first section evaluates non-motor features, the second section assesses activities of daily living, the third section involves motor examination, and the fourth section evaluates treatment complications. The four sections total 42 items. Each item is scored from 0 (no symptoms or signs) to 4 (the most severe symptoms or signs).	up to 8 weeks
New York Postural Assessment Test	For each of the 13 body segments, three diagrams are provided. The posterior view includes the head, shoulders, spine, hips, and feet, while the lateral view includes the neck, chest, shoulders, upper back, trunk, abdomen, and lumbar region. Each body segment is scored as follows: 5 points (correct posture), 3 points (moderate deviation), and 1 point (severe deviation). The total score ranges from 13 to 65. A higher score indicates better posture.	up to 8 weeks
Visual Analog Scale	Pain intensity was assessed using the Visual Analog Scale (VAS), which consists of a 100-mm horizontal line with scores ranging from 0 to 100 mm. Participants were instructed to mark the point on the line that best represented their current pain intensity, where 0 indicated "no pain" and 100 indicated "worst imaginable pain." The distance in millimeters from the left end of the line to the marked point was measured using a ruler. Higher VAS scores indicate greater pain intensity.	up to 8 weeks
Parkinson Fatigue Scale	Consists of a total of 16 questions related to fatigue. Participants are asked to rate their agreement with the statements on a scale from 1 to 5 (1: strongly disagree, 5: strongly agree). The test result is determined by calculating the average of the responses to all questions.	up to 8 weeks
10-Meter Walk Test	Gait speed will be assessed using the 10-Meter Walk Test. Participants will be instructed to walk a marked 10-meter distance at their usual walking speed. The time taken to complete the distance will be recorded, and walking speed (m/s) will be calculated.	up to 8 weeks
Activities-specific Balance Confidence Scale	It consists of 16 tasks related to daily living activities performed both indoors and outdoors. Each item is rated on a scale from 0% (no confidence) to 100% (full confidence). Scores below 67% indicate a risk of falling, while higher scores reflect greater balance confidence.	up to 8 weeks
Functional Reach Test	Postural stability will be assessed using the Functional Reach Test. The participant stands next to a wall with the arm closest to the wall elevated to 90° of shoulder flexion. The initial and final positions of the third finger are marked, and the reach distance (cm) is calculated.	up to 8 weeks
Five Times Sit-to-Stand Test	Lower extremity strength and functional mobility will be evaluated using the Five Times Sit-to-Stand Test. Participants are instructed to stand up and sit down five times as quickly as possible from an armless chair with arms crossed. The total completion time (seconds) is recorded.	up to 8 weeks
Freezing of Gait Questionnaire	Used to assess freezing episodes in patients with Parkinson's disease. It consists of six questions, each scored on a 0 to 4 scale (0: no symptoms, 4: severe). The total score ranges from 0 to 24, with higher scores indicating more severe freezing-related impairment.	up to 8 weeks
Parkinson's Disease Quality of Life Questionnaire (PDQ-39)	İt consists of 39 items divided into eight domains. Participants respond based on their experiences over the past month. Each question is scored on a 0 to 4 scale (0: never, 1: rarely, 2: sometimes, 3: often, 4: always). To calculate the domain score, the total score of the questions within that domain is summed, divided by the maximum possible score for that domain, and multiplied by 100. The total PDQ-39 score is obtained by summing the eight domain scores and dividing by 8, providing an overall quality of life measure.	up to 8 weeks

Collaborators and Investigators

• Sponsor: Hasan Kalyoncu University
• Investigators: Principal Investigator: Büşra Akıncı, Hasan Kalyoncu University; Study Director: Günseli Usgu, Assoc. Prof., Hasan Kalyoncu University

Publications and helpful links

General Publications

• Kim KI, Im SC, Kim K. Effects of trunk stabilization exercises using laser pointer visual feedback in patients with chronic stroke: A randomized controlled study. Technol Health Care. 2023;31(2):471-483. doi: 10.3233/THC-220100.

Study record dates

Study Major Dates

• Study Start (Actual): December 1, 2025
• Primary Completion (Estimated): April 5, 2026
• Study Completion (Estimated): May 5, 2026

Study Registration Dates

• First Submitted: December 5, 2025
• First Submitted That Met QC Criteria: December 22, 2025
• First Posted (Actual): January 7, 2026

Study Record Updates

• Last Update Posted (Actual): January 27, 2026
• Last Update Submitted That Met QC Criteria: January 24, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: exercise; postural control; balance; visual feedback; parkinson disease
• Additional Relevant MeSH Terms: Synucleinopathies; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Neurodegenerative Diseases; Movement Disorders; Parkinsonian Disorders; Basal Ganglia Diseases; Behavior; Parkinson Disease; Motor Activity; Investigative Techniques; Epidemiologic Research Design; Epidemiologic Methods; Research Design; Methods; Control Groups
• Other Study ID Numbers: HKU/Ph/1

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No