Irina Galperin, Anat Irelman, Tanja Shmitz-Hübsch, Katherine L. Hsieh, Keren Regev, Arnon Karni, Marina Brozgol, Pablo Cornejo Thumm, Sharon G. Lynch, Friedemann Paul, Hannes Devos, Jacob Sosnoff, Jeffrey M. Hausdorff
Abstract
Background
Cognitive and motor impairments impact the everyday functioning of people with multiple sclerosis (pwMS). This randomized controlled trial (RCT) evaluated the benefits of a combined virtual reality and motor–cognitive training program on critical cognitive and motor symptoms as well as related outcomes in people with multiple sclerosis.
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. For 6 weeks, each group received three training sessions per week. The primary outcomes were dual-tasking gait speed and cognitive processing speed (Symbol Digit Modalities Test, SDMT, score). Additional tests of cognitive function, mobility, and patient-reported questionnaires were secondary outcomes . Measurements were taken before, after, and three months after training.
Results
Gait speed improved (p < 0.005) similarly by about 10 cm/s in both groups. A clinically meaningful improvement of 4.4 points (95% CI 1.9–6.8, p = 0.001) in SDMT was shown in the TT + VR group (n = 53 analyzed per-protocol), 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). In addition, 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) in the TT + VR group.
Discussion
These findings suggest that both TT + VR and TT improve usual and dual-task gait in people with multiple sclerosis. Furthermore, a VR based multi-modal approach positively impacts multiple aspects of cognitive function and mental health. This is more than seen after treadmill-training alone.
GaitBetter is the commercial implementation of the V-TIME academic research project that yields many of these papers.