{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T14:37:15Z","timestamp":1767969435539,"version":"3.49.0"},"reference-count":55,"publisher":"Public Library of Science (PLoS)","issue":"4","license":[{"start":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T00:00:00Z","timestamp":1743984000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Parkinson\u2019s disease (PD) is a neurodegenerative condition that impacts motor planning and control of the upper limbs (UL) and leads to cognitive impairments. Rehabilitation approaches, including motor imagery (MI) and action observation (AO), along with the use of brain-machine interfaces (BMI), are essential in the PD population to enhance neuroplasticity and mitigate symptoms.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To provide a description of a rehabilitation protocol for evaluating the effects of isolated and combined applications of MI and action observation (AO), along with BMI, on upper limb (UL) motor changes and cognitive function in PD.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This study provides a detailed protocol for a single-blinded, randomized clinical trial. After selection, participants will be randomly assigned to one of five experimental groups. Each participant will be assessed at three points: pre-intervention, post-intervention, and at a follow-up four weeks after the intervention ends. The intervention consists of 10 sessions, each lasting approximately 60 minutes.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Expected results<\/jats:title>\n<jats:p>The primary outcome expected is an improvement in the Test d\u2019\u00c9valuation des Membres Sup\u00e9rieurs de Personnes \u00c2g\u00e9es score, accompanied by a reduction in task execution time. Secondary outcomes include motor symptoms in the upper limbs, assessed via the Unified Parkinson\u2019s Disease Rating Scale - Part III and the 9-Hole Peg Test; cognitive function, assessed with the PD Cognitive Rating Scale; and occupational performance, assessed with the Canadian Occupational Performance Measure.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Discussion<\/jats:title>\n<jats:p>This study protocol is notable for its intensive daily sessions. Both MI and AO are low-cost, enabling personalized interventions that physiotherapists and occupational therapists can readily replicate in practice. While BMI use does require professionals to acquire an exoskeleton, the protocol ensures the distinctiveness of the interventions and, to our knowledge, is the first to involve individuals with PD.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec006\">\n<jats:title>Trial registration<\/jats:title>\n<jats:p>ClinicalTrials.gov <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/clinicaltrials.gov\/ct2\/show\/NCT05696925\" xlink:type=\"simple\">NCT05696925<\/jats:ext-link>.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0315148","type":"journal-article","created":{"date-parts":[[2025,4,7]],"date-time":"2025-04-07T21:14:25Z","timestamp":1744060465000},"page":"e0315148","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":2,"title":["The use of brain-machine interface, motor imagery, and action observation in the rehabilitation of individuals with Parkinson\u2019s disease: A protocol study for a randomized clinical trial"],"prefix":"10.1371","volume":"20","author":[{"given":"K\u00e1tine Marchezan","family":"Estivalet","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tatiana Salayaran de Aguiar","family":"Pettenuzzo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nat\u00e1lia Lopes","family":"Mazzilli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9496-4884","authenticated-orcid":true,"given":"Luis Fernando","family":"Ferreira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernanda","family":"Cechetti","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2025,4,7]]},"reference":[{"issue":"20","key":"pone.0315148.ref001","doi-asserted-by":"crossref","first-page":"7668","DOI":"10.3390\/ijerph17207668","article-title":"Health-related quality of life and physical function in individuals with Parkinson\u2019s disease after a multidisciplinary rehabilitation regimen-a prospective cohort feasibility study","volume":"17","author":"C Nielsen","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0315148.ref002","first-page":"124214","article-title":"Action observation and motor imagery: innovative cognitive tools in the rehabilitation of parkinson\u2019s disease","author":"G Abbruzzese","year":"2015","journal-title":"Parkinsons Dis"},{"key":"pone.0315148.ref003","first-page":"4897276","article-title":"Effect of group-based rehabilitation combining action observation with physiotherapy on freezing of gait in Parkinson\u2019s disease","author":"E Pelosin","year":"2018","journal-title":"Neural Plast"},{"key":"pone.0315148.ref004","first-page":"7047910","article-title":"Patients\u2019 views on a combined action observation and motor imagery intervention for Parkinson\u2019s disease","author":"J Bek","year":"2016","journal-title":"Parkinsons Dis"},{"issue":"1","key":"pone.0315148.ref005","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1111\/nyas.14564","article-title":"Anxiety and cognitive load affect upper limb motor control in Parkinson\u2019s disease during medication phases","author":"Z Nodehi","year":"2021","journal-title":"Ann N Y Acad Sci"},{"key":"pone.0315148.ref006","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/j.cortex.2017.09.022","article-title":"Differential impairments of upper and lower limb movements influence action verb processing in Parkinson disease","volume":"97","author":"A Roberts","year":"2017","journal-title":"Cortex"},{"issue":"9","key":"pone.0315148.ref007","doi-asserted-by":"crossref","first-page":"588","DOI":"10.3390\/brainsci10090588","article-title":"Parkinson\u2019s disease-cognitive rating scale for evaluating cognitive impairment in Parkinson\u2019s disease: a systematic review","volume":"10","author":"EC Rosca","year":"2020","journal-title":"Brain Sci"},{"issue":"1","key":"pone.0315148.ref008","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1590\/1980-57642021dn15-010011","article-title":"Cross-sectional associations between cognition and mobility in Parkinson\u2019s disease","volume":"15","author":"NMF Sousa","year":"2021","journal-title":"Dement Neuropsychol"},{"issue":"2","key":"pone.0315148.ref009","doi-asserted-by":"crossref","first-page":"185","DOI":"10.3390\/brainsci11020185","article-title":"The role of mental imagery in Parkinson\u2019s disease rehabilitation","volume":"11","author":"A Abraham","year":"2021","journal-title":"Brain Sci"},{"key":"pone.0315148.ref010","doi-asserted-by":"crossref","unstructured":"Rizzi B, Nuresi C, Rovacchi C, Bacchini M, Savi F, Falco L. 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