Evaluation of the effectiveness of action observation therapy and mirror therapy on upper extremity functions and quality of life in patients with parkinson

Parkinson's Disease is a neurodegenerative disease with the loss of dopaminergic neurons in the basal ganglia. Clinical findings include bradykinesia, rigidity, resting tremor, and posture disorder. Upper extremity disorders always show an asymmetrical onset and these disorders can cause a decrease in quality of life. The main treatment of the disease is medical, but rehabilitation programs are also applied. Conventional rehabilitation programs include range of motion, stretching, strengthening, balance, posture, walking and breathing exercises. In recent years, new exercise methods have also been used. Among these treatments are action observation therapy and mirror therapy, which aim to organize the neural structures of movement and facilitate movement. This study was designed as a single-blind, randomized controlled trial to evaluate the effects of action observation therapy and mirror therapy on upper extremity functions and quality of life. A total of 45 Parkinson's patients with Hoehn Yahr stage ≤ 3 were divided into 3 groups using the closed envelope method. The first group received only conventional treatment, the second group received action observation therapy in addition to the conventional treatment, and the third group received mirror therapy in addition to the conventional treatment. Hand grip strength, dexterity (Nine Hole Peg Test, Box and Block Test, Minnesota Manual Dexterity Test), quality of life and functionality (Parkinson's Disease Questionnaire, Duruöz Hand Index) and motor development (Unified Parkinson's Assessment Scale (motor examination section) were evaluated. In all tests for dexterity assessment, all groups showed improvement after treatment. In the Nine Hole Peg Test, dexterity in the conventional treatment group decreased significantly at the 3rd month after the treatment compared to the action observation therapy group (p<0.05). In the Box and Block Test, a significant difference was found between the groups in the post-treatment and post treatment measurements at the 3rd month (p<0.05), the improvement in dexterity in the action observation therapy and mirror therapy groups was statistically significant compared to the conventional treatment group (p<0.0167). In the Minnesota Manual Dexterity Test, the difference between the groups was found to be significant in the post-treatment and post-treatment measurements at the 3rd month (p<0.05), in both measurements, there was a significant difference between the conventional treatment group and the action observation therapy and mirror therapy groups in both measurements (p<0.0167). When the hand grip strength values were examined, there was no statistically significant difference between the treatment groups in the measurements of coarse grip, lateral grip, triple grip and end-to-end grip (p>0.05), but improvement was observed in all groups in intragroup assessments. In the 3rd month measurements after the treatment, it was found that the coarse grip and lateral grip strength were decreased in the conventional treatment group, while the grip strength was preserved in the action observation therapy and mirror therapy group. In the Parkinson's Disease Questionnaire applied to evaluate the quality of life, there was an improvement in the quality of life in the post-treatment evaluation in all groups, but there was no significant difference between the post-treatment measurements in the evaluation between the groups (p>0.05). In the Duruöz Hand Index, hand functions were improved in all groups in the post-treatment evaluation, while the improvements in the action observation therapy and mirror therapy group were statistically significant compared to the conventional treatment group (p<0.05). In the motor examination section of the Unified Parkinson's Disease Rating Scale, motor improvement was found in all groups after treatment, but no significant difference was found between the groups in terms of motor improvement (p>0.05). As a result, action observation therapy or mirror therapy added to conventional treatment in Parkinson's patients with impaired upper extremity functions increases hand skills, which positively reflects on functionality and quality of life