Effect of Motor Imagery Added to Rehabilitation on Balance and Kinesiophobia in Patients With Parkinson's Disease

March 29, 2026 updated by: Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital

The Effect of Motor Imagery Added to Conventional Rehabilitation on Balance and Kinesiophobia in Patients With Parkinson's Disease: A Randomized Controlled Trial

Parkinson's Disease (PD) is a progressive brain disorder that affects movement and balance. It can cause slowed movements, stiffness, tremor, balance problems, and an increased risk of falling. Many individuals with PD develop fear of movement, also referred to as kinesiophobia, and fear of falling. This condition may lead to avoidance of physical activity, which can further worsen balance and movement abilities.

This study aims to determine whether adding Motor Imagery (MI) to a standard rehabilitation program can improve balance and reduce fear of movement in individuals with PD. MI is a mental practice technique in which an individual rehearses movements cognitively without actual physical execution. For example, a person may imagine standing up, walking, or climbing stairs. Although the movement is not physically performed, the brain regions involved in movement are activated. MI is safe, does not require special equipment, and may help improve motor control.

Eligible participants will be randomly assigned to one of two groups. One group will receive standard physical therapy and rehabilitation exercises, while the other group will receive the same therapy combined with additional MI training. The rehabilitation program will last six weeks.

The study will primarily evaluate whether this combined approach improves balance and reduces fear of movement. In addition, the potential effects of the intervention on fall risk, functional mobility and performance, fear of falling, activities of daily living, and motor function will also be examined. Assessments will be performed at the beginning of the study, at the end of treatment, and again at 12 weeks.

Researchers hope to determine whether combining MI with conventional rehabilitation provides greater benefits than conventional rehabilitation alone and may help improve rehabilitation strategies for people living with PD.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Parkinson's Disease (PD) is a progressive neurological disorder that affects movement control due to the gradual loss of dopamine-producing neurons. Over time, individuals may experience motor symptoms such as bradykinesia, rigidity, tremor, and impaired postural control. Among these symptoms, balance impairment and postural instability are major contributors to falls and increased fall risk. Falls are common in people with PD and may lead to injury and limitations in safe mobility.

In addition to motor symptoms, psychological factors may influence movement performance. One important factor is kinesiophobia, defined as an excessive fear of movement due to the belief that physical activity may cause falling or injury. Fear of falling may lead individuals to avoid movement and reduce participation in physical activities and rehabilitation programs. Reduced activity levels may contribute to muscle weakness, further balance deterioration, decline in functional performance, and worsening motor abilities. Therefore, rehabilitation strategies that address both motor impairments and movement-related fear are essential.

Conventional rehabilitation programs for PD typically include balance training, gait training, strengthening exercises, and functional mobility tasks. These interventions aim to improve postural control, reduce fall risk, and enhance motor performance. However, the effectiveness of rehabilitation may vary depending on patient engagement, motivation, and psychological readiness for movement.

Motor Imagery (MI) is a technique that involves mentally rehearsing a movement without physically performing it. Neurophysiological research indicates that MI activates neural pathways similar to those involved in actual movement execution. This activation may facilitate motor learning, improve coordination, and enhance balance control. Because MI does not require physical exertion, it may be particularly beneficial for individuals whose participation in physical exercise is limited by balance deficits or fear of falling.

Previous studies in neurological rehabilitation suggest that Motor Imagery (MI) may support improvements in motor performance and balance. However, limited evidence exists regarding its effectiveness in simultaneously improving balance and reducing movement-related fear in individuals with PD.

This study is designed to evaluate whether integrating structured MI sessions into a conventional rehabilitation program provides additional clinical benefits. The primary objective is to determine its effectiveness in improving balance and reducing kinesiophobia. Secondary objectives include examining the effects of the intervention on fall risk, functional performance, fear of falling, activities of daily living, and motor function.

The intervention focuses on functional, everyday movements that are directly associated with balance control and fall prevention. These movements include weight shifting, sit-to-stand transitions, walking, stair negotiation, trunk rotation, reciprocal movements, object retrieval from the floor, as well as rhythmic and coordinated activities such as dance-based movements and step exercises.

MI sessions will follow a structured format. Participants will observe standardized demonstrations of correctly performed functional movements and will then be guided to mentally rehearse these movements using visual imagery and kinesthetic imagery techniques. Immediately after the imagery phase, participants will physically perform the same activities under professional supervision. Exercise difficulty will be progressively adjusted according to individual performance levels to promote improvements in balance, functional mobility, and motor performance.

The rationale for combining mental rehearsal with physical execution is based on principles of motor learning and neuroplasticity. Repeated activation of motor-related neural circuits through both mental and physical practice may enhance postural control, coordination, and movement confidence. Addressing both motor control and movement-related fear may contribute to safer mobility and improved functional performance.

The study is conducted in a clinical rehabilitation setting and follows a randomized controlled parallel-group design. Participants will receive a structured rehabilitation program over a defined treatment period. Follow-up assessments will be conducted immediately after the intervention and at 12 weeks to evaluate the persistence of intervention effects.

The anticipated contribution of this study is to clarify whether Motor Imagery (MI) provides additional benefits beyond conventional rehabilitation in improving balance and reducing movement-related fear in individuals with PD. If proven effective, MI may represent a safe and easily implementable approach to enhance rehabilitation strategies.

Study Type

Interventional

Enrollment (Estimated)

42

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

  • Name: Büşranur Kurtça Güdük, MD
  • Phone Number: +905536267034
  • Email: bsrnrk92@gmail.com

Study Contact Backup

Study Locations

  • Turkey (Türkiye)
    • Istanbul
      • Istanbul, Istanbul, Turkey (Türkiye), 34785
        • Recruiting
        • Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Diagnosis of Parkinson's Disease (PD)
  • Age 40 years or older
  • Hoehn and Yahr stage between 1 and 3
  • Mini-Mental State Examination (MMSE) score of 22 or higher

Exclusion Criteria:

  • Presence of an additional neurological disorder
  • Movement impairment or nerve damage due to orthopedic pathology
  • Cardiopulmonary conditions that contraindicate exercise participation
  • Presence of severe dyskinesia
  • Visual or vestibular impairments that may affect balance
  • Presence of motor fluctuations (on-off periods)
  • Deep brain stimulation for Parkinson's Disease

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Active Comparator: Conventional Rehabilitation Group
Participants will receive a structured conventional rehabilitation program including balance training, gait training, strengthening exercises, and functional mobility exercises
Behavioral: Conventional Rehabilitation
A structured physiotherapy program focusing on balance, gait, strength, and functional mobility training
Other Names:
  • Control
Experimental: Motor Imagery + Conventional Rehabilitation Group
Participants will receive traditional rehabilitation along with motor imagery training.
Behavioral: Conventional Rehabilitation
A structured physiotherapy program focusing on balance, gait, strength, and functional mobility training
Other Names:
  • Control
Behavioral: Motor Imagery Training
A structured motor imagery program including guided visual and kinesthetic mental rehearsal of functional movements, applied in addition to conventional rehabilitation.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from baseline in kinesiophobia
Time Frame: Baseline, at 6 weeks (end of intervention), and at 12 weeks follow-up
Kinesiophobia will be assessed using the Tampa Scale for Kinesiophobia (TSK-17). The TSK-17 is a self-reported questionnaire used to evaluate fear of movement or re-injury. Higher scores indicate greater levels of kinesiophobia.
Baseline, at 6 weeks (end of intervention), and at 12 weeks follow-up
Change from baseline in balance performance
Time Frame: Baseline, at 6 weeks (end of intervention), and at 12 weeks follow-up
Balance performance will be assessed using the Berg Balance Scale (BBS). The BBS is a widely used clinical scale consisting of 14 functional tasks that evaluate static and dynamic balance abilities. Higher scores indicate better balance performance.
Baseline, at 6 weeks (end of intervention), and at 12 weeks follow-up

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change from baseline in fall risk and functional mobility
Time Frame: Baseline, at 6 weeks (end of intervention), and at 12 weeks follow-up
Fall risk and functional mobility will be assessed using the Timed Up and Go (TUG) test, which measures the time required for a participant to stand up from a chair, walk three meters, turn, walk back, and sit down.
Baseline, at 6 weeks (end of intervention), and at 12 weeks follow-up
Change from baseline in motor function
Time Frame: Baseline, at 6 weeks (end of intervention), and at 12 weeks follow-up
Motor function will be assessed using Part III of the Unified Parkinson's Disease Rating Scale (UPDRS-III), which evaluates motor symptoms including tremor, rigidity, and bradykinesia in individuals with Parkinson's Disease.
Baseline, at 6 weeks (end of intervention), and at 12 weeks follow-up

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sehit Prof. Dr. Ilhan Varank Sancaktepe Training and Research Hospital

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

January 2, 2026

Primary Completion (Estimated)

June 25, 2026

Study Completion (Estimated)

June 30, 2026

Study Registration Dates

First Submitted

March 21, 2026

First Submitted That Met QC Criteria

March 21, 2026

First Posted (Actual)

March 27, 2026

Study Record Updates

Last Update Posted (Actual)

April 2, 2026

Last Update Submitted That Met QC Criteria

March 29, 2026

Last Verified

March 1, 2026

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • MI-PD-2026-01

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

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

Clinical Trials on Parkinson Disease (PD)

Clinical Trials on Conventional Rehabilitation

Search Similar Trials

Sponsors and Collaborators

Medical Conditions

Drug Interventions

CROs by country

CROs in Papua New Guinea

Conditions

Rare Diseases

Drug Interventions

Dietary Supplements

Sponsor/Collaborators

Locations

Subscribe