Comparison of neuroplasticity based balance training versus conventional physiotherapy among patients with parkinson’s disease
DOI:
https://doi.org/10.61581/mjsp.v7i03.405Keywords:
Parkinson, neuroplasticity, Balance training, Traditional physiotherapy, Berg Balance ScaleAbstract
Objective:This study aim was to compare the implications of neuroplasticity-based balance training on balance and functional mobility with conventional physiotherapy to establish the most superior intervention for Parkinson Disease patients.
Methodology:This RCT was carried out at Amna Medicare Hospital in Multan over four months from 2nd May 2025 to 31st Aug 2026.The study included 66 participants (33 per group) aged 50–70 years with diagnosed Parkinson’s disease and balance or gait impairments, taking stable antiparkinsonian medication and able to walk independently or with assistance. Group A: received balance training based on the concept of neuroplasticity (including weight shifting, obstacle negotiation, unstable surface activities and dual task training). Conventional physiotherapy consisting of range of motion, stretches, strengthens, posture and balance exercises was performed on Group B. Both groups saw 40 minutes of supervised attendance per week in a four week period (20 supervised sessions total), with 5 sessions per week, plus warm up and cool down. Following four weeks, functional mobility (Timed Up and Go) and balance (Berg balance scale) were evaluated at both baseline and after four weeks. The data were analysed in SPSS 26.0 and Microsoft Excel. The means and standard deviations of descriptive statistics were used and the Shapiro–Wilk test, paired-sample t test and independent-sample t test were also used. The criterion of the statistical significance was set to p < .05.
Results: After four weeks, there was a statistically significant balance and functional mobility improvement that occurred between the two groups (p < .001). Group A showed an improvement in the mean of 36.30 ± 2.30 to 48.52 ± 2.09 on the Berg Balance Scale and -1.66 to -1.34 on Timed Up and Go (p = 0.001 each). Cohen d values were reported were 1.49 and 1.53 respectively.
Conclusion: Post intervention results were better in immediate balance and functional mobility and balance training with neuroplasticity is better than traditional physiotherapy in this sample. The findings indicate that incorporating increasing challenge–task-specific tasks of diminishing stability in rehab of Parkinson disease is warranted. The difference in baseline balance-score between the groups and lack of long-term follow-up should be accounted in the interpretation.
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References
1. Alotaibi S, Alfayez L, Alkhudhair M. Parkinson's Disease: Current Treatment Modalities and Emerging Therapies. Cureus. 2024;16(12):e75647.
2. Hoskovcová M, Růžička E, Gál O, On Behalf Of The i C-PC. The Category of Conventional Physiotherapy: The Case of Parkinson's Disease Guidelines. J Pers Med. 2022;12(5).
3. Camargo CHF, Ferreira-Peruzzo SA, Ribas DIR, Franklin GL, Teive HA. Imbalance and gait impairment in Parkinson’s disease: discussing postural instability and ataxia. Neurological Sciences. 2024;45(4):1377-88.
4. Mylius V, Zenev E, Brook CS, Brugger F, Maetzler W, Gonzenbach R, et al. Imbalance and Falls in Patients with Parkinson's Disease: Causes and Recent Developments in Training and Sensor-Based Assessment. Brain Sci. 2024;14(7).
5. Li M, Ye X, Huang Z, Ye L, Chen C. Global burden of Parkinson's disease from 1990 to 2021: a population-based study. BMJ Open. 2025;15(4):e095610.
6. Mehdizadeh M, Fereshtehnejad S-M, Landers MR, Taghavi Azar Sharabiani P, Shati M, Mortazavi SS, et al. Responsiveness of the mini-balance evaluation systems test, dynamic gait index, Berg balance scale, and performance-oriented mobility assessment in parkinson’s disease. Scientific Reports. 2025;15(1):21126.
7. Du Y-H, Ma J, Hu J-Y, Zhu L, Wang L-Y, Yang R-Y, et al. Effects of dual-task training on gait and motor ability in patients with Parkinson's disease: A systematic review and meta-analysis. Clinical Rehabilitation. 2023;37(7):942-53.
8. Imama S, Zameer Z. Emerging Paradigms in Exercise-Based Neuro-Physiotherapy for Holistic Motor and Cognitive Rehabilitation in Parkinson’s Disease: Neuro-Physiotherapy in Parkinson’s Disease. THE THERAPIST (Journal of Therapies & Rehabilitation Sciences). 2024:02-10.
9. Coelho DB, de Oliveira CEN, Guimarães MVC, Ribeiro de Souza C, dos Santos ML, de Lima-Pardini AC. A systematic review on the effectiveness of perturbation-based balance training in postural control and gait in Parkinson’s disease. Physiotherapy. 2022;116:58-71.
10. Freidle M, Johansson H, Ekman U, Lebedev AV, Schalling E, Thompson WH, et al. Behavioural and neuroplastic effects of a double-blind randomised controlled balance exercise trial in people with Parkinson’s disease. npj Parkinson's Disease. 2022;8(1):12.
11. Maiora J, Rezola-Pardo C, García G, Sanz B, Graña M. Older adult fall risk prediction with deep learning and timed up and go (TUG) test data. Bioengineering. 2024;11(10):1000.
12. Cardini R, Gervasoni E, Giannoni-Luza S, Cavalca A, Piva A, Cattaneo D, et al. Physiotherapy interventions for balance impairments in Parkinson’s disease: evidence from a systematic review and dose-response meta-analysis. npj Parkinson's Disease. 2026.
13. Hameed S, Figari-Jordan R. Parkinson's disease care in Pakistan: overcoming challenges in low- and middle-income countries. BMJ Neurology Open. 2026;8(1):e001516.
14. Sampaio T, Encarnação S, Santos O, Narciso D, Oliveira JP, Teixeira JE, et al., editors. The effectiveness of Pilates training interventions on older adults’ balance: a systematic review and meta-analysis of randomized controlled trials. Healthcare; 2023: MDPI.
15. Weise D, Claus I, Dresel C, Kalbe E, Liepelt-Scarfone I, Lorenzl S, et al. Multidisciplinary care in Parkinson's disease. J Neural Transm (Vienna). 2024;131(10):1217-27.
16. Kumar S, Goyal L, Singh S. Tremor and rigidity in patients with Parkinson’s disease: emphasis on epidemiology, pathophysiology and contributing factors. CNS & Neurological Disorders-Drug Targets-CNS & Neurological Disorders). 2022;21(7):596-609.
17. Zikereya T, Shi K, Chen W. Goal-directed and habitual control: from circuits and functions to exercise-induced neuroplasticity targets for the treatment of Parkinson’s disease. Frontiers in neurology. 2023;14:1254447.
18. Liu H-H, Wang R-Y, Cheng S-J, Liao K-K, Zhou J-H, Yang Y-R. Balance Training Modulates Cortical Inhibition in Individuals with Parkinson’s Disease: A Randomized Controlled Trial. Neurorehabilitation and Neural Repair. 2022;36(9):613-20.
19. Ellis TD, Colón-Semenza C, DeAngelis TR, Thomas CA, Hilaire MS, Earhart GM, et al. Evidence for Early and Regular Physical Therapy and Exercise in Parkinson's Disease. Semin Neurol. 2021;41(2):189-205.
20. Lena F, Modugno N, Greco G, Torre M, Cesarano S, Santilli M, et al. Rehabilitation Interventions for Improving Balance in Parkinson’s Disease: A Narrative Review. American Journal of Physical Medicine & Rehabilitation. 2023;102(3):270-4.
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Copyright (c) 2026 Mahnoor Shabbir, Azhar Akram
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