Type of Article:  Original Research

Volume 7; Issue 4 (August 2019)

Page No.: 3207-3213

DOI: https://dx.doi.org/10.16965/ijpr.2019.160


Marya Lokhandwala, Vivek Kulkarni *, Manasa Nair.

11/12, Thube Park, Shivajinagar, Pune, Maharashtra, India.

Address for Correspondence: Dr. Manasa Nair, 1/12, Thube Park, Shivajinagar, Pune, Maharashtra 411005, India. E-Mail: manasanair22@gmail.com


Objectives: To compare the effects of combined mental and physical practice with physical practice alone on functional independence in Parkinson disease patients.

Study design: Randomized control trial.

Setting: Tertiary health care center

Participants: 30 subjects were recruited with idiopathic Parkinson’s disease, 60-75 years of age, who were between 1.5 -3 on the Hoehn & Yahr classification & had a score of 24 on the modified Mini Mental State Examination (MMSE). They were randomly assigned into two groups i.e. the experimental group (N=15) which received physical practice along with mental imagery & the control group (N=15) which received physical practice alone.

Outcome measures: Performance time of functional movement tasks such as supine to standing position & then standing to supine position were measured. In addition to this the Timed Up& Go (TUG) test and the mental, motor & ADL subsets of the Unified Parkinson’s Disease Rating Scale (UPDRS) & Stroop test for cognitive assessment were administered.

Results: There was a significant difference in the performance time of supine to standing & standing to supine position (p 0.00), TUG test (p 0.003) & Stroop test errors (p 0.004). However there was no significant difference in the UPDRS and stroop test time scores.

Conclusion: This study shows that the experimental group performed better during the functional tasks and cognitive Stroop test, however there was no significant improvement in UPDRS scores.

Key words: Mental practice, functional independence, Parkinson’s disease.


  1. Pringsheim T, Jette N, Frolkis A, Steeves TD. The prevalence of Parkinson’s disease: A systematic review and meta‐analysis. Movement disorders. 2014 Nov;29(13):1583-90.
  2. Sveinbjornsdottir S. The clinical symptoms of Parkinson’s disease. Journal of neurochemistry. 2016 Oct 1;139(S1):318-24.
  3. Jankovic J. Parkinson’s disease: clinical features and diagnosis. Journal of neurology, neurosurgery & psychiatry. 2008 Apr 1;79(4):368-76.
  4. Lees, Andrew J.; Hardy, John; Revesz, Tamas (2009-06-13). “Parkinson’sdisease”.
  5. Williams-Gray CH, Foltynie T, Brayne CE, Robbins TW, Barker RA. Evolution of cognitive dysfunction in an incident Parkinson’s disease cohort. Brain. 2007 May29;130(7):1787-98.
  6. Keus SH, Munneke M, Graziano M, Paltamaa J, Pelosin E, Domingos J, Brühlmann S, Ramaswamy B, Prins J, Struiksma C, Rochester L. European physiotherapy guideline for Parkinson’s disease. Royal Dutch society for physical therapy (KNGF) and ParkinsonNet. 2014 Dec.
  7. Marchese R, Diverio M, Zucchi F, Lentino C, Abbruzzese G. The role of sensory cues in the rehabilitation of parkinsonian patients: a comparison of two physical therapy protocols. Movement Disorders. 2000 Sep1;15(5):879-83.
  8. Morris ME. Movement disorders in people with Parkinson disease: a model for physical therapy. Physical therapy. 2000 Jun1;80(6):578-97.
  9. Visualimageryandtheuseofmentalpracticeinthedevelopmentofmotorskills. Canadian journal of applied sport sciences. Journal canadien des sciences appliquees au sport. 1985 Dec;10(4):4S-16S.
  10. Munzert J, Lorey B, Zentgraf K. Cognitive motor processes: the role of motor imagery in the study of motor representations. Brain research reviews. 2009 May31;60(2):306-26.
  11. Theneurologicalbasisofmentalimagery:Acomponentialanalysis.Cognition.1984 Dec 31;18(1):245-72.
  12. Dalla-Corte A, das Neves CM, Anés M, Portuguez MW, Dacosta JC. The Effect of Handedness on Supplementary Motor Area Activation during Complex Motor Tasks. Journal of Behavioral and Brain Science. 2015 Sep10;5(10):458.
  13. Decety J,Jeannerod M,Prablanc C.The timing of mentally represented actions. Behavioural brain research. 1989 Aug 1;34(1):35-42.
  14. Page SJ, Levine P, Sisto SA, Johnston MV. Mental practice combined with physical practice for upper-limb motor deficit in subacute stroke. Physical Therapy. 2001 Aug 1;81(8):1455-62
  15. Fansler CL, Poff CL, Shepard KF. Effects of mental practice on balance in elderly women. Physical Therapy. 1985 Sep 1; 65(9):1332-8.
  16. Gregg M, Hall C, Butler A. The MIQ-RS: a suitable option for examining movement imagery ability. Evidence-Based Complementary and Alternative Medicine. 2010;7(2):249-57.
  17. Dickstein R, Deutsch JE. Motor imagery in physical therapist practice. Physical therapy. 2007 Jul 1;87(7):942-53.
  18. Twining WE. Mental practice and physical practice in learning a motor skill. Research Quarterly. American Association for Health, Physical Education and Recreation. 1949 Dec 1;20(4):432-5.
  19. Schenkman M, Ellis T, Christiansen C, Barón AE, Tickle-Degnen L, Hall DA, Wagenaar R. Profile of functional limitations and task performance among people with early-and middlestage Parkinson disease. Physical therapy. 2011 Sep 1;91(9):1339-54.
  20. Glickstein M, Stein J. Paradoxical movement in Parkinson’s disease. Trends in neurosciences. 1991 Nov 30;14(11):480-2
  21. Giladi N, McDermott MP, Fahn S, Przedborski S, Jankovic J, Stern M, Tanner C, Parkinson Study Group. Freezing of gait in PD Prospective assessment in the DATATOP cohort. Neurology. 2001 Jun 26;56(12):1712-21.
  22. Morris ME, Iansek R, Matyas TA, Summers JJ. Stride length regulation in Parkinson’s disease: normalization strategies and underlying mechanisms. Brain. 1996 Apr 1;119(2):551- 68.
  23. Fahn SE. Unified Parkinson’s disease rating scale. Recent developments in Parkinson’s disease. 1987;2:153
  24. Harrison MB, Wylie SA, Frysinger RC, Patrie JT, Huss DS, Currie LJ, Wooten GF. UPDRS activity of daily living score as a marker of Parkinson’s disease progression. Movement disorders. 2009 Jan 30;24(2):224-30.
  25. Paivio A. Cognitive and motivational functions of imagery in human performance. Canadian journal of applied sport sciences. Journal canadien des sciences appliquées au sport. 1985 Dec;10(4):22S-8S.
  26. Moench L. The Development Of Mental Processing Efficiency Working Memory And Thinking. Development. 2016 Aug 11;1:2.

Cite this article: Marya Lokhandwala, Vivek Kulkarni, Manasa Nair. COMPARISON OF COMBINED EFFECTS OF PHYSICAL AND MENTAL PRACTICE WITH PHYSICAL PRACTICE ALONE ON FUNCTIONAL INDEPENDENCE IN PARKINSON (PD) PATIENTS. Int J Physiother Res 2019;7(4):3207-3213. DOI: 10.16965/ijpr.2019.160