Case Report Functional Outcomes of Task-Oriented Circuit Training in a Middle-Aged Male with Vascular Parkinsonism and Recurrent Stroke: A Case Report
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Dec 24, 2025
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Abstract
Introduction: Vascular parkinsonism (VP) due to small-vessel disease markedly impairs mobility and quality of life. As VP patients respond poorly to dopaminergic therapy, structured exercise rehabilitation is essential. This case report examines the functional outcomes of a six-week task-oriented circuit training (TOCT) program in a 59-year-old man with chronic VP (>6 months, four prior events).
Presentation/Case Description: A 59-year-old male with VP from recurrent ischemic infarcts presented with gait unsteadiness, bradykinesia, and limited community ambulation. A six-week rehabilitation program centered on TOCT, integrating balance, gait, and functional task practice, was implemented. This was supplemented with aerobic conditioning and stretching. Post-intervention assessment revealed improvements in balance, walking endurance, pain reduction, and functional independence.
Discussion: The structured TOCT protocol, emphasizing high repetition of task-specific movements and progressive challenges, effectively addressed the postural instability and endurance deficits characteristic of VP. The combination of TOCT with aerobic exercise provided a comprehensive approach to improve motor performance and patient-reported outcomes.
Conclusions: An individualized six-week multidisciplinary rehabilitation program improved balance, endurance, pain, and QoL in a patient with VP; however, these findings are limited by the descriptive single-case design and require confirmation in larger, randomized, and blinded studies.
Keywords : quality of life, rehabilitation, small vessel disease, stroke, TOCT, vascular parkinsonism.
Presentation/Case Description: A 59-year-old male with VP from recurrent ischemic infarcts presented with gait unsteadiness, bradykinesia, and limited community ambulation. A six-week rehabilitation program centered on TOCT, integrating balance, gait, and functional task practice, was implemented. This was supplemented with aerobic conditioning and stretching. Post-intervention assessment revealed improvements in balance, walking endurance, pain reduction, and functional independence.
Discussion: The structured TOCT protocol, emphasizing high repetition of task-specific movements and progressive challenges, effectively addressed the postural instability and endurance deficits characteristic of VP. The combination of TOCT with aerobic exercise provided a comprehensive approach to improve motor performance and patient-reported outcomes.
Conclusions: An individualized six-week multidisciplinary rehabilitation program improved balance, endurance, pain, and QoL in a patient with VP; however, these findings are limited by the descriptive single-case design and require confirmation in larger, randomized, and blinded studies.
Keywords : quality of life, rehabilitation, small vessel disease, stroke, TOCT, vascular parkinsonism.
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How to Cite
Kusuma, M. H. N., Vitriana, Novitri, & Tanuwidjaja, D. (2025). Case Report Functional Outcomes of Task-Oriented Circuit Training in a Middle-Aged Male with Vascular Parkinsonism and Recurrent Stroke: A Case Report. Indonesian Journal of Physical Medicine and Rehabilitation, 14(2), 257 - 262. https://doi.org/10.36803/indojpmr.v14i2.519
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Case Report
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References
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13. Pelicioni PHS, Lord SR, Menant JC, Chaplin C, Canning C, Brodie MA, et al. Combined reactive and volitional step training improves balance recovery and stepping reaction time in people with Parkinson’s disease: a randomised controlled trial. Neurorehabil Neural Repair [Internet]. 2023 Oct 21;37(10):694–704.
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15. Lohmann LH, Zech A, Plöschberger G, Oraže M, Jochum D, Warneke K. Acute and chronic effects of stretching on balance: a systematic review with multilevel meta-analysis. Front Med. 2024;11:1–15.
16. Duñabeitia I, González-Devesa D, Blanco-Martínez N, Ayán-Pérez C. The effects of stretching in Parkinson’s disease: a systematic review of randomized controlled trials. Parkinsonism Relat Disord. 2025;134:1–10.
17. Kim R, Lee TL, Lee H, Ko D-K, Lee JH, Shin H, et al. Effects of physical exercise interventions on cognitive function in Parkinson’s disease: an updated systematic review and meta-analysis of randomized controlled trials. Parkinsonism Relat Disord [Internet]. 2023 Dec;117:105908.
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2. del Toro-Pérez C, Guevara-Sánchez E, Martínez-Sánchez P. Treatment of vascular parkinsonism: a systematic review. Brain Sci. 2023;13(3):1–17.
3. Chen K, Tan Y, Lu Y, Wu J, Liu X, Zhao Y. Effect of exercise on quality of life in Parkinson’s disease: a systematic review and meta-analysis. Parkinsons Dis. 2020;2020:1–12.
4. Eldemir S, Guclu-Gunduz A, Eldemir K, Saygili F, Yilmaz R, Akbostanci MC. The effect of task-oriented circuit training-based telerehabilitation on upper extremity motor functions in patients with Parkinson’s disease: a randomized controlled trial. Parkinsonism Relat Disord [Internet]. 2023 Apr;109:105334.
5. El-Sayed MS, Kilany A, El Shemy SA. Efficacy of task-oriented circuit training on gait kinematics, pelvic symmetry and trunk endurance in children with hemiplegia: a randomized controlled trial. J Musculoskelet Neuronal Interact [Internet]. 2025 Mar 1;25(1):36–46.
6. Udagedara T, Dhananjalee Alahakoon AB, Goonaratna I. Vascular parkinsonism: a review on management updates. Ann Indian Acad Neurol [Internet]. 2019;22(1):17–24. A
7. Low DC, Walsh GS. The minimal important change for measures of balance and postural control in older adults: a systematic review. Age Ageing [Internet]. 2022 Dec 5;51(12):1–11.
8. Soke F, Guclu-Gunduz A, Kocer B, Fidan I, Keskinoglu P. Task-oriented circuit training combined with aerobic training improves motor performance and balance in people with Parkinson’s disease. Acta Neurol Belg [Internet]. 2021 Apr 18;121(2):535–43.
9. Ernst M, Folkerts A-K, Gollan R, Lieker E, Caro-Valenzuela J, Adams A, et al. Physical exercise for people with Parkinson’s disease: a systematic review and network meta-analysis. Cochrane Database Syst Rev [Internet]. 2023 Jan 5;2023(5):1–25.
10. Zhen K, Zhang S, Tao X, Li G, Lv Y, Yu L. A systematic review and meta-analysis on effects of aerobic exercise in people with Parkinson’s disease. NPJ Parkinsons Dis [Internet]. 2022 Oct 31;8(1):146.
11. Miguel-Puga A, Villafuerte G, Salas-Pacheco J, Arias-Carrión O. Therapeutic interventions for vascular parkinsonism: a systematic review and meta-analysis. Front Neurol. 2017;8:1–12.
12. Zhou X, Zhao P, Guo X, Wang J, Wang R. Effectiveness of aerobic and resistance training on the motor symptoms in Parkinson’s disease: systematic review and network meta-analysis. Front Aging Neurosci [Internet]. 2022 Aug 1;14:935176.
13. Pelicioni PHS, Lord SR, Menant JC, Chaplin C, Canning C, Brodie MA, et al. Combined reactive and volitional step training improves balance recovery and stepping reaction time in people with Parkinson’s disease: a randomised controlled trial. Neurorehabil Neural Repair [Internet]. 2023 Oct 21;37(10):694–704.
14. Leavy B, Löfgren N, Nilsson M, Franzén E. Patient-reported and performance-based measures of walking in mild–moderate Parkinson’s disease. Brain Behav [Internet]. 2018 Sep 22;8(9):e01081.
15. Lohmann LH, Zech A, Plöschberger G, Oraže M, Jochum D, Warneke K. Acute and chronic effects of stretching on balance: a systematic review with multilevel meta-analysis. Front Med. 2024;11:1–15.
16. Duñabeitia I, González-Devesa D, Blanco-Martínez N, Ayán-Pérez C. The effects of stretching in Parkinson’s disease: a systematic review of randomized controlled trials. Parkinsonism Relat Disord. 2025;134:1–10.
17. Kim R, Lee TL, Lee H, Ko D-K, Lee JH, Shin H, et al. Effects of physical exercise interventions on cognitive function in Parkinson’s disease: an updated systematic review and meta-analysis of randomized controlled trials. Parkinsonism Relat Disord [Internet]. 2023 Dec;117:105908.
18. Hayashi S, Miyata K, Takeda R, Iizuka T, Igarashi T, Usuda S. Minimal clinically important difference of the Berg Balance Scale and comfortable walking speed in patients with acute stroke: a multicenter, prospective, longitudinal study. Clin Rehabil [Internet]. 2022 Nov 21;36(11):1512–23.