Effectiveness of mirror visual feedback therapy combined with home dexterity program as compared to home dexterity program in improving hand function of patients with Parkinson's disease

To compare the effect of Mirror Visual feedback therapy combined with a home dexterity program and home dexterity program in improving hand function of patients with Parkinson's Disease

Two arms Parallel group, single-blind, randomized controlled trial

• The study will be conducted in Neurology department Fauji Foundation Hospital. • Patient will be included in study after taking full informed consent. • Participants will be screened thoroughly for any exclusion, before getting enrolled. • Severity of disease will be determined by means of the MDS Unified Parkinson Disease Rating Scale, Part III: Motor (MDS-UPDRS III).

Inclusion Criteria: All patients with stages 1to 3 in Hoehn and Yahr and who would be on a stable medication regimen. Patients with impaired hand dexterity Exclusion Criteria: 1. Patients with history of other neurological conditions, 2. deep brain stimulation, 3. Patients cognitive status < 24, 4. Patients with visual field defects, which will prevent the patient to see their reflection of hand 5. Patients with severe orthopedic conditions of upper limb

The intervention group (Mirror visual feedback therapy combined with home dexterity program group) will receive Mirror visual feedback therapy combined with home based dexterity Program for 1 hour 3 times a week for 6 weeks. A patient will have to perform six various types of exercises, either bi-manually or unimanually, Both hands will have to be trained equally. The control group (Home dexterity program group) will receive only home dexterity program for 1 hour 3 times a week for 6 weeks

Independent Variable: • Mirror Therapy combined with Home based dexterity program • Home dexterity program Dependent Variables: • Hand function

Random assignment was used for treatment using a sealed envelope. For that, 30 sheets of aluminum paper are properly cut. This paper should be double the size of the paper. 15 Sheets of Carbon paper cut into appropriate size according to the paper used. A standard-sized square paper was taken in which group "(Mirror visual feedback therapy combined with home dexterity program)" was marked. In this way, 15 papers were prepared marked with "(Mirror visual feedback therapy combined with home dexterity program)" and 15 square-shaped papers marked with "(Home dexterity program)". The sheet of paper on which either (Mirror visual feedback therapy combined with home dexterity program) or (Home dexterity program) was marked was folded to fit the envelope. A sheet of Carbon paper was placed on the top of the folded paper (marked either (Mirror visual feedback therapy combined with home dexterity program) or (Home Dexterity Program) facing the envelope. Then the sheet of Aluminum foil was wrapped on the carbon paper (with folded paper inside). All the above prepared were placed in the envelope (which was completely opaque), the envelope was then sealed. In this way 15 envelops of "(Mirror visual feedback therapy combined with home dexterity program)" and 15 envelops of "(Home Dexterity Program)" were prepared with a total number of 30 envelopes. These 30 envelopes were then thoroughly shuffled like a deck of cards. The envelopes were then marked with numbers 1-30. Each participant picked the envelope in order from 1-30 and was given an intervention (Mirror visual feedback therapy combined with home dexterity program or Home Dexterity program) accordingly.

Only the researcher doing the study knows which treatment or intervention the participant is receiving. It makes results less likely to be biased. For that, they received an additional device that is not connected and they feel they are receiving treatment apart from their actual treatment.

Due to ethical Considerations