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

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.