Comparison of an Eight-week Training Program with and without Virtual Reality on Motor and Cognitive Performance of Women with Multiple Sclerosis

authors:

avatar Seyedehomme Eiman Razavi ORCID 1 , avatar Mohammad Hossein Alizadeh ORCID 2 , * , avatar Somayeh Namdar Tajari ORCID 3

Department of Sports Science, University of Tehran Kish International Campus, Kish, Iran
Department of Sports Injury and Biomechanics, Faculty of Sport Sciences and Physical Education, University of Tehran, Iran
Department of Motor Behavior, Faculty of Sports Science, University of Mazandaran, Babolsar, Iran
International Journal of Motor Control and Learning: Vol.5, issue 2; 10-18
published online: May 13, 2023
article type: Research Article
received: February 02, 2023
accepted: May 09, 2023
DOI: https://doi.org/10.61186/ijmcl.5.2.10

how to cite: Razavi S E, Alizadeh M H, Namdar Tajari S. Comparison of an Eight-week Training Program with and without Virtual Reality on Motor and Cognitive Performance of Women with Multiple Sclerosis. J Motor Control Learn. 2023;5(2):e144168. https://doi.org/10.61186/ijmcl.5.2.10.

Abstract

Background: This study compared the effect of training programs with and without virtual reality (VR) on the motor and cognitive performance of women with Multiple Sclerosis (MS). 
Methods: It was a Quasi-experimental study with two experimental groups (17 participants in each group) and a control group (15 participants). Participants have Relapsing-remitting multiple sclerosis and were 20 to 40 years old, and living in Amol City. There were three groups: the experimental group exercised with VR (T+VR), the experimental group exercised without VR (T), and the control group didn't have any exercise intervention. The exercise intervention was carried out for eight weeks (twice a week) including five stages: warming up the body, walking on a treadmill, resting, soccer goalkeeping, and cooling down. The tools used for pre-test and post-test measurement were: Expanded Disability Status Scale Borg Rating of the Perceived Exertion, timed 25-Foot Walk Test, Berg Balance Scale, Timed Up and Go Test, Fatigue Severity Scale, Depression, Anxiety and Stress Scale Questionnaire, Mini-Mental State Examination test, Tower of London test. Analysis of covariance and Bonferroni pairwise comparison was used for data analysis. 
Results: The results showed that the eight-week exercise program with and without VR effectively increased static and dynamic balance and improved the mental state of women with MS (P<0.05), But no significant difference was observed between the two groups in comparison to the control group. Also, the training program with and without VR affected improving walking speed, reducing the intensity of fatigue, stress, anxiety, and depression, and increasing the problem-solving ability of women with multiple sclerosis (P<0.05). This effectiveness in the T+VR group was more than in the T group. 
Conclusion: Performing sports training with and without VR has a significant effect on the motor and cognitive performance of women with multiple sclerosis, but training with VR can be a motivating and effective alternative for the motor and cognitive rehabilitation of women with multiple sclerosis.

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References

  • 1.

    Bahar-Fuchs, A. Clare, L. Woods, B. (2013). "Cognitive training and cognitive rehabilitation for persons with mild to moderate dementia of the Alzheimer’s or vascular type: a review", Journal of alzheimers res, 5(1): 35-45.

  • 2.

    Bayrami, M. Hassimi, T. Taher Akdam, A.A. Alilou, M. Nikzad, B. (2015). “Comparison of Cognitive performances in patients with multiple sclerosis with healthy people”, Journal of rehabilitation research in nursing, 1(3): 13-23.

  • 3.

    Calabro, R.S. Russo, M. Naro, A. De Luca, R. Leo, A. Tomasello, P. Molonia, F. Dattola, V. Bramanti, A. Bramanti, P. (2017). "Robotic gait training in multiple sclerosis rehabilitation: can virtual reality make the difference? Findings from a randomized controlled trial", Journal of neurol. sci, 377(11): 25–30.

  • 4.

    Castellano-Aguilera, A. Bivia-Roig, G. Cuenca-Martinez, F. SusoMarti, L. Calatayud, J. Blanco-Diaz, M. Casana, J. (2022). "Effectiveness of virtual reality on balance and risk of falls in people with multiple sclerosis: A systematic review and meta-analysis", Journal of environmental research and public health, 19(21).

  • 5.

    Clemenson, G.D. Stark, C.E.L. (2015). "Virtual environmental enrichment through video games improves hippocampalassociated memory", Journal of neurosci, 35(6): 16116– 16125.

  • 6.

    Ebrahimi Atri, A. Saeedi, M. Sarvari, F. Khorshid Sokhangooy, M. (2012). “The Effect of Aquatic Exercise Program on Fatigue in Women with Multiple Sclerosis”, Journal of Mazandaran Univ Med Sci, 22(94): 54-61.

  • 7.

    Ernst, A. (2020). "Autobiographical memory and future thinking impairments in multiple sclerosis: Cognitive and neural mechanisms, functional impact and rehabilitation", Journal of annals of physical and rehabilitation medicine, 63(2):159- 166.

  • 8.

    Eslami, P. Manshaee, G.H. Hajebrahimi, Z. (2014). “Effectiveness of Virtual Reality on Alleviating Fear of Flying in People with Aviophob.

  • 9.

    Faryabi, M.R. (2014). “Application of virtual reality”, The first national conference of new achievements in engineering and basic sciences, Zemin Kav Research Center, Tehran, pp: 1-6.

  • 10.

    Fjeldstad, C. Pardo, G. Frederiksen, C. Bemben, D. Bemben, M. (2009). "Assessment of postural balance in multiple sclerosis", Journal of MS care, 11(1):1-5.

  • 11.

    Fulk, G.D. (2005). "Locomotor training and virtual reality-based balance training for an individual with multiple sclerosis: A case report", Journal of Neurol.Phys.Ther,29(1):34–42.

  • 12.

    Ganry, L. Hersant, B. Sidahmed-Mezi, M. Dhonneur, G. Meningaud, J.P. (2018). "Using virtual reality to control preoperative anxiety in ambulatory surgery patients: A pilot study in maxillofacial and plastic surgery", Journal of stomatology, oral and maxillofacial surgery, 119(4): 257- 261.

  • 13.

    Giordano, A. Granella, F. Lugaresi, A. Martinelli, V. Trojano, M. Confalonieri, P. SIMS-Trial Group. (2011). "Anxiety and depression in multiple sclerosis patients around diagnosis", Journal of the neurological sciences, 307(1-2): 86-91.

  • 14.

    Hsieh, K.L. Mirelman, A. Shema-Shiratzky, S. Galperin, I. Regev, K. Shen, S. Schmitz-Hübsch, T. Karni, A. Paul, F. Devos, H. Sosnoff, J.J. Hausdorff, J.M. (2020). "A multi-modal virtual reality treadmill intervention for enhancing mobility and cognitive function in people with multiple sclerosis: Protocol for a randomized controlled trial", Journal of contemporary clinical trials, 97(5): 106-122.

  • 15.

    Jalili, F. Nejati, V. Ahadi, H. Katanforosh, S.A. (2019). “Effectiveness of computerized motion-based cognitive rehabilitation on improvement of working memory of children with ADHD”, Journal of medical science (Islamic Azad University), 29(2): 171-180.

  • 16.

    Jonsson, A. Andresen, J. Storr, L. Tscherning, T. Soelberg, S.P. Ravnborg, M. (2006). "Cognitive impairment in newly diagnosed multiple sclerosis patients: A 4-year follow-up study", Journal of Neurol Sci, 245(1-2): 77-85.

  • 17.

    Kamalzadeh, H. Abedini, S. (2015). “The use of ICT in the treatment of multiple sclerosis patients: remote rehabilitation”, The 12th International MS Congress of Iran, Sari.

  • 18.

    Kaveh, A. (2018). "Comparison of the five personality factors, locus of control and coping with stress in patients with multiple sclerosis and healthy people in Alborz Province", Journal of revista publicando, 5(14): 560-572.

  • 19.

    Kashani, V.A. Salmanzadeh, M.R. Bahrami, L. (2017). “Validity and reliability of the Persian version of the short leaf balance test in the elderly”, Journal of Kumesh, 20(1): 25-33.

  • 20.

    Kazemi, Z. Mehryar, A.H. Javidi, H.A. Rezaee, A. (2023). “Effect of cognitive-emotional rehabilitation on cognitive function and memory of patients with traumatic brain injury”, Journal of rehabilitation medicine (SJRM), 11(6): 967-977.

  • 21.

    Kern, S. Schultheiss, T. Schneider, H. Schrempf, W. Reichmann, H. Ziemssen, T. (2011). "Circadian cortisol, depressive symptoms and neurological impairment in early multiple sclerosis", Journal of psychoneuroendocrinology, 36(10): 1505-1512.

  • 22.

    Ketelhut, N.B. Kindred, J.H. Manago, M.M. (2015). "Core muscle characteristics during walking of patients with multiple sclerosis", Journal of rehabilitation research and development, 52(6): 713-725.

  • 23.

    Khan, F. Amatya, B. Galea, M. (2014). "Management of fatigue in persons with multiple sclerosis", Journal of frontiers in neurology,5(1):177-185.

  • 24.

    Korthauer, L.E. Nowak, N.T. Frahmand, M. Driscoll, I. (2017). "Cognitive correlates of spatial navigation: associations between executive functioning and the virtualMorrisWater Task", Journal of Behav. Brain Res, 317(22): 470–478.

  • 25.

    Laver, K.E. Lange, B. George, S. Deutsch, J.E. Saposnik, G. Crotty, M. (2017). "Virtual reality for stroke rehabilitation", Journal of cochrane database syst rev, 20(11): 49-83.

  • 26.

    Lozano-Quilis, J.A. Gil-Gomez, H. Gil-Gomez, J.A. Albiol-Perez, S. Palacios-Navarro, G. Fardoun, H.M. Mashat, A.S. (2014). "Virtual rehabilitation for multiple sclerosis using a kinectbased system: Randomized controlled trial", Journal of JMIR serious games, 2(2): 1-12.

  • 27.

    Maggio, M.G. Russo, M. Foti Cuzzola, M. Destro, M. Larosa, G. Molonia, F. Bramanti, P. Lombardo, G. De Luca, R. Salvatore Calabrò, R. (2019). "Virtual reality in multiple sclerosis rehabilitation: A review on cognitive and motor outcomes", Journal of clinical neuroscience, 65(1): 106-111.

  • 28.

    Manuli, A. Grazia Maggio, M. Tripoli, D. Gulli, M. Cannavٍ , A. La Rosa, G. Sciarrone, F. Avena, G. Salvatore Calabrٍ , S. (2020). "Patients' perspective and usability of innovation technology in a new rehabilitation pathway: An exploratory study in patients with multiple sclerosis", Journal of multiple sclerosis and related disorders, 44(1): 1-9.

  • 29.

    Mir, H. Mofazzal Jahromi, M.A. Barati, M. Abdoli, A. (2018). “The role of infectious agents in the etiology of multiple sclerosis”, Journal of paramedical sciences and military health, 13(3): 73-81.

  • 30.

    Motaharinezhad, F. Parvaneh, SH, Ghahari, S. Bakhtiary, A.H. Biglarian, A. Sokhangoye, Y. Forwel, S. (2015). “Validation of persian version of comprehensive fatigue assessment battery for multiple sclerosis (CFAB-MS)” Journal of Mazandaran Univ Med Sci, 25(131): 56-66.

  • 31.

    Moghadasi, M. (2020). “Effect of 8 weeks resistance training on hypothalamo-pituitary-adrenal axis, psychological status and depression level in female patients with Multiple Sclerosis (MS)”, Journal of sport and biomotor sciences, 12(24): 11- 18.

  • 32.

    Najafi, B. (2018). “Investigating the effect of combined exercise protocol on postural control, motor function, fatigue and quality of life of people with multiple sclerosis”, PHD Thesis, School of physical education and sports sciences, University of Tehran.

  • 33.

    Novak, D. Riener, R. (2013). "Enhancing patient freedom in rehabilitation robotics using gaze-based intention detection", IEEE Int.Conf. Rehabil.Robot.

  • 34.

    Ortiz Gutiérrez, R. Galán Del Río, F. Cano De La Cuerda, R. Alguacil Diego, I.M. Arroyo González, R. Juan Carlos Miangolarra Page, J. (2013). "A telerehabilitation program by virtual reality-video games improves balance and postural control in multiple sclerosis patients", Journal of neuro rehabilitation, 33(4): 545-454.

  • 35.

    Ozkula, C. Guclu-Gunduza, A. Yazicia, G. Atalay Guzela, N. Irkecb, C. (2020). "Effect of immersive virtual reality on balance, mobility, and fatigue in patients with multiple sclerosis: A single-blinded randomized controlled trial", Journal of integrative medicine, 35(1): 1-9.

  • 36.

    - Patterson, D.R. Jensen, M.P. Wiechman, S.A. Sharar, S.R. (2010). "Virtual reality hypnosis for pain associated with recovery from physical trauma. Journal of clinical and experimental hypnosis, 58(3): 288-300.

  • 37.

    Patti, F. Leone, C. D'Amico, E. (2010). "Treatment options of cognitive impairment in multiple sclerosis", Journal of Neurol Sci,31(2): 265-269.

  • 38.

    Penner, I.K. Mcdougall, F. Brown, T.M. Slota, C. Doward, L. Julian, L. Belachew, S. Miller, D. (2020). "Exploring the impact of fatigue in progressive multiple sclerosis: A mixed-methods analysis", Journal of multiple sclerosis and related disorders, 43(1): 1-12.

  • 39.

    Peruzzi, A. Cereatti, A. Croce, U.D. Mirelmanc, A. (2016). "Effects of a virtual reality and treadmill training on gait of subjects with multiple sclerosis: A pilot study", Journal of multiple sclerosis and related disorders, 5(1): 91-96.

  • 40.

    Prabhakar, A.R. Marwah, N. Raju, O.S. (2007). "A comparison between audio and audiovisual distraction techniques in managing anxious pediatric dental patients", Journal of indian society of pedodontics and preventive dentistry, 25(4): 177-189.

  • 41.

    Prosperini, L. Fortuna, D. Giannì, C. Leonardi, L. Pozzilli, C. (2013). "The diagnostic accuracy of static posturography in predicting accidental falls in people with multiple sclerosis", Journal of neurorehabilitation and neural repair,27(1): 45-52.

  • 42.

    Raghibi, M. Khosravi, M. (2012). “Comparing the cognitive function in multiple sclerosis patients”, Journal of research in medical sciences, 14(2): 45-48.

  • 43.

    Ravanmard, S. (2018). “The effect of mental imagery of sports activity on anxiety and depression of MS patients”, Master's thesis, Higher education institute of Azerbaijan's Charkh Nilofar.

  • 44.

    Repetto, C. Serino, S. Macedonia, M. Riva, G. (2016). "Virtual reality as an embodied tool to enhance episodic memory in elderly", Journal of Front. Psychol. 7(1):18-39.

  • 45.

    Saladino, M.L. Gualtieri, C. Scaffa, M. Lopatin, M.F. Kohler, E. Bruna, P. Blaya, P. Testa, C. Lopez, G. Reyna, M. Piedrabuena, R. Mercante, S. Barboza, A. Caceres, F.J. (2023). "Neuro rehabilitation effectiveness based on virtual reality and tele rehabilitation in people with multiple sclerosis in Argentina: Reavitelem study", Journal of multiple sclerosis and related disorders, 70(2023).

  • 46.

    Salvatore Calabrò, R. Russo, M. Naro, A. De Luca, R. Leo, A. Tomasello, P. Molonia, F. Dattola, V. Bramanti, A. Bramanti, P. (2017). "Robotic gait training in multiple sclerosis rehabilitation: Can virtual reality make the difference? Findings from a randomized controlled trial", Journal of neurological sciences, 377(12): 25-30.

  • 47.

    Santos Nascimento, A. Vieira Fagundes, C. Augusto Dos Santos Mendes, F. Cerqueira Leal, J. (2021). "Effectiveness of virtual reality rehabilitation in persons with multiple sclerosis: a systematic review and meta-analysis of randomized controlled trials", Journal of multiple sclerosis and related disorders, 54(2021).

  • 48.

    Serino, S. Pedroli, E. (2016). "Technology and cognitive empowerment for healthy elderly: the link between cognitive skills", Journal of Integr. Technol. Posit. Psychol. Pract. 193(51): 21-35.

  • 49.

    Sharar, S.R. Carrougher, G.J. Nakamura, D. Hoffman, H.G. Blough, D.K. Patterson, D.R. (2007). "Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies", Journal of physical medicine and rehabilitation, 88(12): 43-49.

  • 50.

    Saadat, S. Kalantari, M. Kajbaf, M.B. Hosseininezhad, M. (2019). “Comparison of Psychological Symptoms in Multiple Sclerosis Patients and Normal People”, Journal of medical science (Islamic Azad University), 26(6): 73-83.

  • 51.

    Seifadini Zarandi, E. Amir Seifadini, M.R. Mohammadi Pour, F. (2016). “Acute effects of music therapy session with a different rhythmic structures on gait parameters in patients with MS”, Journal of research in sports rehabilitation, 4(7): 11-20.

  • 52.

    Sheikholeslami-Vatani, D. Ghaderi Almaneh, G. (2019). “Positive effects of progressive resistance training on physical fitness indices in patients with multiple sclerosis”, Journal of practical studies of biosciences in sport, 7(13): 31-42.

  • 53.

    Salehi, M. Mohamadzade, H. Rasti, J. Etemadi Far, M. (2021). “The effect of aerobic exercise, virtual reality and dual tasks exercise on motor function and depression in depressed MS patients”, Journal of motor behavior, Accepted manuscript available online.

  • 54.

    Socie, M.J. Sosnoff, J.J. (2013). "Gait variability and multiple sclerosis", Journal of Mult.Scler.Int. Available at: (http://www.pubmedcentral.nih.gov/articlerender.

  • 55.

    Sosnoff, J.J. Sandroff, B.M. Motl, R.W. (2012). "Quantifying gait abnormalities in persons with multiple sclerosis with minimal disability", Journal of gait & posture, 36(1):154-156.

  • 56.

    Swank, C. Thompson, M. Medley, A. (2013). "Aerobic exercise in people with multiple sclerosis: its feasibility and secondary benefits", Journal of MS care, 15(3):138-145.

  • 57.

    Taheri, S. Parvinpour, SH. Balali, M. (2022). “The effect of eight weeks of virtual reality-based physical training on kinematic indicators of gait, muscle strength, and balance in women with Multiple Sclerosis”, Journal of advances in cognitive sciences, 24(3): 1-16.

  • 58.

    Winter, C. Kern, F. Gall, D. Erich Latoschik, M. Pauli, P. Kathner, I. (2021). "Immersive virtual reality during gait rehabilitation increases walking speed and motivation: a usability evaluation with healthy participants and patients with multiple sclerosis and stroke", Journal of neuroengineering and rehabilitation, 68(18): 1-14.

  • 59.

    Yazgan, Y.Z. Tarakci, E. Tarakci, D. Ozdincler, A.R. Kurtuncu, M. (2020). "Comparison of the effects of two different exergaming systems on balance, functionality, fatigue, and quality of life in people with multiple sclerosis: A randomized controlled trial", Journal of multiple sclerosis and related disorders, 39(1): 1-17.

  • 60.

    Zamani, S.N. Rahmati, A. Fazilat-Pour, M. (2014). “The Effect of Cognitive – Behavioral Stress Management Training on Anxiety, Depression and Cognitive Disorder of Individuals with Multiple Sclerosis”, Journal of clinical psychology, 5(4): 43-54.