EFFECTS OF REMOTE MENTAL PRACTICE ON FREEZING OF GAIT IN PEOPLE WITH PARKINSON'S DISEASE: A RANDOMIZED CONTROLLED TRIAL

• Grant number: 25/14403-7
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)
• Start date: August 01, 2025
• End date: July 31, 2026
• Field of knowledge: Health Sciences - Physiotherapy and Occupational Therapy
• Principal Investigator: Maria Elisa Pimentel Piemonte
• Grantee: Paloma Rodrigues da Silva
• Host Institution: Faculdade de Medicina (FM). Universidade de São Paulo (USP). São Paulo , SP, Brazil
• Associated research grant: 13/07699-0 - Research, Innovation and Dissemination Center for Neuromathematics - NeuroMat, AP.CEPID

Abstract

INTRODUCTION: Freezing of gait (FOG) is one of the most disabling symptoms of Parkinson's disease (PD) and shows limited response to conventional therapies. Mental practice (MP), especially when combined with physical practice (PP) - as in Dynamic Neuro-Cognitive Imagery (DNI) - has shown promise by activating compensatory cortical circuits essential for motor control. However, its effectiveness, particularly in remote formats, remains underexplored. Technologies such as functional near-infrared spectroscopy (fNIRS) and GAITRite offer innovative tools to assess both clinical and neurophysiological effects. OBJECTIVE: To compare the effects of a remote intervention combining DNI-based MP with a control intervention consisting solely of PP on FOG severity in individuals with PD. METHODS: A single-blind, randomized controlled trial will be conducted with individuals diagnosed with idiopathic PD and confirmed FOG. Participants will be randomly assigned to two groups: experimental (MP and PP) and control (PP and stretching), both undergoing 10 standardized remote sessions. Assessments will be conducted at four time points: baseline, post-intervention, and 30- and 60-day follow-ups. Primary outcomes include cortical activity (fNIRS) and gait parameters (GAITRite). Secondary outcomes include the Rapid Turn Test, %FOG, NFOG-Q, MDS-UPDRS, PDQ-39, and MoCA. Statistical analysis will be performed using repeated-measures ANOVA. EXPECTED RESULTS: The DNI-based intervention is expected to reduce the frequency and duration of FOG episodes, promote gains in autonomy and quality of life, expand access to rehabilitation, and contribute - through fNIRS - to the understanding of compensatory cortical mechanisms, supporting the development of effective and scalable therapeutic strategies. (AU)