The aim of this study is to compare the effects of tele-rehabilitation-based synchronous and asynchronous dual-task upper extremity training with clinical based dual-task upper extremity training and conventional single-task upper extremity training in patients with Parkinson's disease. The main questions it aims to answer are:
* Whether there are differences in motor symptoms, hand dexterity, upper extremity functions, grip strength, executive functions, daily living activities, and treatment satisfaction between tele-rehabilitation-based synchronous and asynchronous dual-task upper extremity training, clinical-based dual-task upper extremity training, and conventional single-task upper extremity training in patients with Parkinson's disease. * Whether there is a difference in telemedicine satisfaction between tele-rehabilitation-based synchronous and asynchronous dual-task upper extremity training in patients with Parkinson's disease.
Researchers will compare conventional single-task upper extremity training, clinical-based dual-task upper extremity training, tele-rehabilitation-based synchronous upper extremity training and tele-rehabilitation-based asynchronous upper extremity training.
Participants will:
* Receive upper extremity exercise training at the study clinic or home, twice a week for approximately 60 minutes each time, for 6 weeks. * Participate in assessments at the study clinic before and after exercise training.
Having been diagnosed with Parkinson's disease by a neurologist according to the UK Brain Bank criteria
Being in stage 3 or higher according to the Hoehn-Yahr Scale
Having a caregiver capable of providing the necessary assistance during tele-rehabilitation sessions and using the required equipment and programs.
Having the device and software to conduct remote video calls for tele-rehabilitation
Presence of a neurological disease other than Parkinson's disease
Cognitive impairment (Standardized Mini Mental Test score less than 24)
Having undergone deep brain stimulation surgery
Having a visual, auditory, or perceptual problem
Parallel
Conventional Single Task Upper Extremity Exercise Training
Other interventionConventional single task upper extremity exercise training at clinical setting. The first 5 minutes of the training session will consist of a warm-up period of stretching and breathing exercises, followed by a cool-down period of the same exercises.Nine different upper extremity activities (using a fork and spoon, tying shoelaces, reaching, throwing a ball, filling water, folding a sheet, drawing shapes, buttoning, and fastening nuts) will be performed for 3 minutes each, in a random order. A 2-minute rest period will be given between each activity.
Clinic-Based Dual Task Upper Extremity Exercise Training
Other interventionDual task upper extremity exercise training at clinical setting. The first 5 minutes of the training session will consist of a warm-up period of stretching and breathing exercises, followed by a cool-down period of the same exercises.Nine different upper extremity activities (using a fork and spoon, tying shoelaces, reaching, throwing a ball, filling water, folding a sheet, drawing shapes, buttoning, and fastening nuts) will be performed simultaneously with three randomly selected cognitive tasks (arithmetic task, verbal fluency, digit span) for 3 minutes each, in a random order. A 2-minute rest period will be given between each activity.
Tele-Rehabilitation Based Synchronous Dual Task Upper Extremity Exercise Training
Other interventionDual task upper extremity exercise training at patient's home, synchronous with a researcher via tele-rehabilitation method. The first 5 minutes of the training session will consist of a warm-up period of stretching and breathing exercises, followed by a cool-down period of the same exercises.Nine different upper extremity activities (using a fork and spoon, tying shoelaces, reaching, throwing a ball, filling water, folding a sheet, drawing shapes, buttoning, and fastening nuts) will be performed simultaneously with three randomly selected cognitive tasks (arithmetic task, verbal fluency, digit span) for 3 minutes each, in a random order. A 2-minute rest period will be given between each activity.
Tele-Rehabilitation Based Asynchronous Dual Task Upper Extremity Exercise Training
Other interventionDual task upper extremity exercise training at patient's home, asynchronous under a researcher supervision. It will be carried out according to the pre-determined schedule and will be video recorded. The first 5 minutes of the training session will consist of a warm-up period of stretching and breathing exercises, followed by a cool-down period of the same exercises.Nine different upper extremity activities (using a fork and spoon, tying shoelaces, reaching, throwing a ball, filling water, folding a sheet, drawing shapes, buttoning, and fastening nuts) will be performed simultaneously with three randomly selected cognitive tasks (arithmetic task, verbal fluency, digit span) for 3 minutes each, in a random order. A 2-minute rest period will be given between each activity.
Unified Parkinson's Disease Rating Scale (UPDRS) - PART 3
UPDRS is a reliable and valid scale that assesses cognitive skills, mood, daily living activities, motor skills, motor fluctuations, dyskinesias and autonomic dysfunction and is widely used in clinical studies and research in Parkinson's disease. The motor symptoms section, which is the third section of this scale, will be used.
Hoehn & Yahr Scale
It is a staging system that provides information quickly in determining the severity and symptoms of Parkinson's disease.
Nine-Hole Peg Test
During the test, individuals use only one hand to pick up nine wooden pegs one by one and insert them into the holes as quickly as possible. After inserting all the pegs, they quickly place them back into the container one by one. The timer starts when the individual touches the first peg and ends when the last peg is placed back into the container.
Coin Rotation Test
This test assesses the coordination of independent finger movements. In this test, the person is asked to rotate a coin 180 degrees as many times as possible between their thumb, index finger, and middle finger within 10 seconds without dropping it. The person's performance is video recorded and later analyzed. An increase in the number of times the patient rotates the coin within 10 seconds indicates better fine motor skills.
Treatment Satisfaction
Patient satisfaction with treatment will be assessed post-treatment using a 100 mm long visual-analog scale.
Telemedicine Satisfaction Questionnaire
This survey consists of 14 items. It assesses patients' satisfaction levels with the software or system they use for treatment or other remote rehabilitation services. The total score ranges from 14 to 70, with a maximum of 5 points per question. A higher score indicates higher satisfaction.
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Saglik Bilimleri Universitesi
Lead sponsor
Anadolu University
Collaborator
Eskisehir Osmangazi University
Collaborator
