TY - JOUR
T1 - Treadmill training with virtual reality to enhance gait and cognitive function among people with multiple sclerosis
T2 - a randomized controlled trial
AU - Galperin, Irina
AU - Mirelman, Anat
AU - Schmitz-Hübsch, Tanja
AU - Hsieh, Katherine L.
AU - Regev, Keren
AU - Karni, Arnon
AU - Brozgol, Marina
AU - Cornejo Thumm, Pablo
AU - Lynch, Sharon G.
AU - Paul, Friedemann
AU - Devos, Hannes
AU - Sosnoff, Jacob
AU - Hausdorff, Jeffrey M.
N1 - Funding Information:
This work was supported in part by a grant from the National Multiple Sclerosis Society (RG-1507-05433). We thank Shirley Shema-Shirtzky, MPT, David Buzaglo, BPT, John Estes, MPT, Erin Holtmeier, DPT, Alexis Bieker, SPT, Kari Hughes, BS, Iarina Devos, BA, Amber Conn, OT for invaluable assistance with the training and assessment of the subjects. We thank Eran Gazit for engineering assistance and Shahar Yehezkiyahu for assistance with data entry. We thank Emma Lieker, Dr. rer. medic. Verena Schwachmeyer Dr.med. Maria Rönnefarth from training and supervision at BIH, Berlin, Germany. Additionally, we are grateful to the study participants for their time and effort.
Funding Information:
JJS reports funding from the National Institute of Health (R21AG073892, R21AG064308-01), National Multiple Sclerosis Society (MB-1807-31633, RG-1701-26862), ownership in Sosnoff Technologies, LLC, speaking fees from BrainWeek, and consulting fees from Xavor, Inc. AM and JMH report have submitted a patent application on the use of virtual reality, the intellectual property rights for which are held by the Tel Aviv Medical Center. None of the other authors have potential conflicts of interest to be disclosed.
Publisher Copyright:
© 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
PY - 2023/3
Y1 - 2023/3
N2 - Background: Motor and cognitive impairments impact the everyday functioning of people with MS (pwMS). The present randomized controlled trial (RCT) evaluated the benefits of a combined motor–cognitive virtual reality training program on key motor and cognitive symptoms and related outcomes in pwMS. Methods: In a single-blinded, two-arm RCT, 124 pwMS were randomized into a treadmill training with virtual reality (TT + VR) group or a treadmill training alone (TT) (active-control) group. Both groups received three training sessions per week for 6 weeks. Dual-tasking gait speed and cognitive processing speed (Symbol Digit Modalities Test, SDMT, score) were the primary outcomes. Secondary outcomes included additional tests of cognitive function, mobility, and patient-reported questionnaires. These were measured before, after, and 3 months after training. Results: Gait speed improved (p < 0.005) in both groups, similarly, by about 10 cm/s. The TT + VR group (n = 53 analyzed per-protocol) showed a clinically meaningful improvement of 4.4 points (95% CI 1.9–6.8, p = 0.001) in SDMT, compared to an improvement of only 0.8 points in the TT (n = 51 analyzed per-protocol) group (95% CI 0.9–2.5 points, p = 0.358) (group X time interaction effect p = 0.027). Furthermore, TT + VR group-specific improvements were seen in depressive symptoms (lowered by 31%, p = 0.003), attention (17%, p < 0.001), and verbal fluency (11.6% increase, p = 0.002). Discussion: These findings suggest that both TT and TT + VR improve usual and dual-task gait in pwMS. Nonetheless, a multi-modal approach based on VR positively impacts multiple aspects of cognitive function and mental health, more than seen after treadmill-treading alone. Trial registered at ClinicalTrials.Gov NCT02427997.
AB - Background: Motor and cognitive impairments impact the everyday functioning of people with MS (pwMS). The present randomized controlled trial (RCT) evaluated the benefits of a combined motor–cognitive virtual reality training program on key motor and cognitive symptoms and related outcomes in pwMS. Methods: In a single-blinded, two-arm RCT, 124 pwMS were randomized into a treadmill training with virtual reality (TT + VR) group or a treadmill training alone (TT) (active-control) group. Both groups received three training sessions per week for 6 weeks. Dual-tasking gait speed and cognitive processing speed (Symbol Digit Modalities Test, SDMT, score) were the primary outcomes. Secondary outcomes included additional tests of cognitive function, mobility, and patient-reported questionnaires. These were measured before, after, and 3 months after training. Results: Gait speed improved (p < 0.005) in both groups, similarly, by about 10 cm/s. The TT + VR group (n = 53 analyzed per-protocol) showed a clinically meaningful improvement of 4.4 points (95% CI 1.9–6.8, p = 0.001) in SDMT, compared to an improvement of only 0.8 points in the TT (n = 51 analyzed per-protocol) group (95% CI 0.9–2.5 points, p = 0.358) (group X time interaction effect p = 0.027). Furthermore, TT + VR group-specific improvements were seen in depressive symptoms (lowered by 31%, p = 0.003), attention (17%, p < 0.001), and verbal fluency (11.6% increase, p = 0.002). Discussion: These findings suggest that both TT and TT + VR improve usual and dual-task gait in pwMS. Nonetheless, a multi-modal approach based on VR positively impacts multiple aspects of cognitive function and mental health, more than seen after treadmill-treading alone. Trial registered at ClinicalTrials.Gov NCT02427997.
KW - Dual task
KW - Gait
KW - Multiple sclerosis
KW - Treadmill training
KW - Virtual reality
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U2 - 10.1007/s00415-022-11469-1
DO - 10.1007/s00415-022-11469-1
M3 - Article
C2 - 36357586
AN - SCOPUS:85141726358
SN - 0340-5354
VL - 270
SP - 1388
EP - 1401
JO - Journal of Neurology
JF - Journal of Neurology
IS - 3
ER -