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 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.