Upper limb rehabilitation in Parkinson’s disease; matching motor learning strategies and the person’s cognitive profile

INTERVENTION: Intervention program will be administered twice a week, 45 minute sessions, for 5 weeks by a qualified Occupational Therapist with experience with Parkinson's Disease (PD). both groups (intervention and comparator group) will receive intervention in one‐on‐one sessions once a week face to face in the Clinic or the patient's home and once a week on zoom from the patient’s home. intervention description: Motor Imagery intervention‐ practice of dexterity exercises will be performed after imagining the exercise in the first person. After imagining the movement, the patient will perform the activity with the hand that he was instructed to imagine using. For Activities of Daily Living (ADL) which are unilateral practice will be performed only with the dominant arm – following imagery of the activity. For bilateral ADL’s practice will be performed after imagining the activity. Motor imagery will be performed with the verbal guidance of the Occupational Therapist. After 3 weeks both groups will be asked to give 2‐3 dexterity based activities that are meaningful and difficult for them in daily function, those activities will be integrated into the intervention. Session attendance will be followed and reported. CONDITION: Neurological ‐ Parkinson's disease Parkinson's Disease; ; Parkinson's Disease Physical Medicine / Rehabilitation ‐ Occupational therapy PRIMARY OUTCOME: The Canadian Occupational Performance measure (COPM) is a semi‐structured interview measuring self‐perceived performance.; [Prior to intervention initiation, at intervention end and at a 4 week follow up.] Time of completion of a functional task will be recorded (and videotaped conditioned on the participant’s consent): Taking out 2 coins, 2 bills and a credit card from a wallet and placing them on the table.; ; [Prior to intervention initiation, at intervention end and at a 4 week follow up.; ] Time of completion of a functional task will be recorded (and videotaped conditioned on the participant’s consent): Writing/typing task.; [Prior to intervention initiation, at intervention end and at a 4 week follow up.; ] INCLUSION CRITERIA: INCLUSION CRITERIA: PD diagnosis of at least two years, Hoehn and Yahr =>2, existence of lateralization determined by the Unified Parkinson’s Disease Rating Scale motor examination and the patient subjective report. SECONDARY OUTCOME: The Coin Rotation Task is a test measuring hand dexterity. The task requires the participant to rotate a U.S. nickel (in Israel will be performed with a 10 agorot coin) through consecutive 1800 turns using the thumb, inde Xand middle fingers, as rapidly as possible for 20 rotations.[Prior to intervention initiation, at intervention end and at a 4 week follow up.] The dexterity questionnaire (DextQ‐36 ‐ revised) : The DextQ‐36 ‐ revised is a patient‐reported dexterity questionnaire regarding ADL functions that require comple XUL function. It is based on the dextQ‐24 and approval was attained from the main author to perform an official translation process as well as changes to items. [Prior to intervention initiation, at intervention end and at a 4 week follow up.] The Movement Disorder Society ‐ Unified Parkinson’s Disease Rating Scale (MDS‐UPDRS). In this research the ADL section (part II) as well as the upper limb items and the pull test from the MDS‐UPDRS motor test (III) will be administered.[Prior to intervention initiation, at intervention end and at a 4 week follow up.] The Nine Hole Peg Test (NHPT) assesses finger dexterity by measuring the time it takes to insert and remove nine small pegs into a wooden board. [Prior to intervention initiation, at intervention end and at a 4 week follow up.] The TATOO is a touchscreen assessment tool that measures hand dexterity abilities (developed by Danial‐Saad& Chiari, 2017). It tests intentional movements aimed at touchscreen use such as tapping, swiping, pinching and other motor activities of the hand. [Prior to intervention initiation, at intervention end and at a 4 week follow up.]