Trunk Control Exercises and Mirror Therapy on Balance and Posture in Parkinson's Disease

Parkinson's disease (PD) is movement disorder of the nervous system that worsens over time. As nerve cells (neurons) in parts of the brain weaken or are damaged or die, people may begin to notice problems with movement, tremor, stiffness in the limbs or the trunk of the body, or impaired balance. As these symptoms become more obvious, people may have difficulty walking, talking, or completing other simple tasks. Not everyone with one or more of these symptoms has PD, as the symptoms appear in other diseases as well. Both non-modifiable (age, gender) and modifiable risk factors such as occupation, exposure to pesticides, and depression have an association with PD. Several studies have suggested that Parkinson disease is more common in men. The MT mechanism is based on the concept of visual illusion. The movement of the non-paretic part in front of the mirror (reflective side) is perceived as that of the paretic body part (hidden beside the mirror). MT allows an individual to have an experience of normal movement, even for the severely paralyzed limb. In addition, wherever other rehabilitation methods fail to induce normal movements without any compensation, MT may act as a foundation step for further motor therapy. The perception of movement illusion, a neuropsychological phenomenon may induce neural activation of the lesioned brain and enhance associated motor recovery. Therefore the aim of this study is to compare the effects of truck control exercise program and mirror therapy on balance and postural instability in patients with Parkinson's disease.

Screening: Patients will be screened to meet inclusion criteria. The consent form will be taken from patients then patients will be randomly allocated into two groups (28 in each group). Patients fulfilling the inclusion criteria will be randomly divided into experimental and control groups using the computer software. The study will be single-blinded. The assessor will be unaware of the treatment given to both groups. Data will be collected at baseline and then at the end of the sixth week. Before applying intervention, Berg Balance scale will be used to measure level of balance and goniometer will be used to measure two-dimensional angular deviations between the pelvis and the upper part of the trunk.

Inclusion criteria

• • 50-70 age(Bomasang-Layno et al., 2015)

• Both genders (Bomasang-Layno et al., 2015)
• Patient with grade 1,2,3 Parkinsonism (according to Hoehn and Yahr scale)
• Patient taking fixed dose of medicines
• No cognitive impairment (according to Mini-Mental scale 24-30 scoring) (Capecci et al., 2014)
• The patient was able to get out of chairs and beds without assistance (Hoffmann et al., 2016).
• Individuals without significant dyskinesias or "on-off" periods.(Lötzke et al., 2015)

Exclusion criteria

• • Patient having any recent episode of epilepsy(Bomasang-Layno et al., 2015)

• Patient has had any recent trauma. (Hong et al., 2009)
• Individuals free from chronic diseases such as unstable cardiovascular disease that could compromise their safety during training or testing (Hoffmann et al., 2016).