Mental Rotation and Motor Imagery Training in Multiple Sclerosis

August 5, 2026 updated by: Ramazan KURUL, Abant Izzet Baysal University

Mental Rotation and Motor Imagery Training for Upper-Extremity Function in Relapsing-Remitting Multiple Sclerosis: A Randomized Controlled Trial

This randomized controlled trial investigated the effects of sequential laterality, motor imagery, and mental rotation training in individuals with relapsing-remitting multiple sclerosis. Both groups received conventional physiotherapy, while the intervention group received structured cognitive-motor training and the control group received active visual-attention training.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

Fifty-four participants were randomly assigned to the intervention or control group. Both groups received 45-minute sessions three times per week for six weeks. Mental rotation ability was the primary outcome, while upper-extremity function, manual ability, motor imagery, grip strength, dexterity, and information-processing speed were assessed as secondary outcomes. Assessments were performed before and after the intervention by a researcher blinded to group allocation.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Interventional

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
54

Phase

Phase

The stage of a clinical trial studying a drug or biological product, based on definitions developed by the U.S. Food and Drug Administration (FDA). The phase is based on the study's objective, the number of participants, and other characteristics. There are five phases: Early Phase 1 (formerly listed as Phase 0), Phase 1, Phase 2, Phase 3, and Phase 4. Not Applicable is used to describe trials without FDA-defined phases, including trials of devices or behavioral interventions.
  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Turkey (Türkiye)
      • Bolu, Turkey (Türkiye), 14100
        • Abant Izzet Baysal University Faculty of Health Science

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Adult
  • Older Adult

Accepts Healthy Volunteers

No

Description

Inclusion Criteria:

  • Diagnosed with definite relapsing-remitting multiple sclerosis by a neurologist according to the revised McDonald criteria
  • Not experiencing an acute MS relapse
  • Mini Mental State Examination score ≥24
  • No clinical MS relapse within the previous 3 months
  • No corticosteroid treatment for an MS relapse within the previous 3 months
  • Expanded Disability Status Scale score between 1.5 and 6.0
  • Modified Ashworth Scale score ≤2
  • Sufficient communication ability to understand visual and verbal instructions and follow the training protocol
  • Able to attend at least 80% of the planned sessions
  • Able to complete the Movement Imagery Questionnaire-3

Exclusion Criteria:

  • Any medication change within the previous 3 months
  • Uncorrected severe visual or hearing impairment
  • A communication disorder preventing the perception of or response to the visual and verbal stimuli used in the study
  • Participation in another structured upper-extremity rehabilitation program or interventional study during the study period
  • Presence of an additional neurological disorder
  • Advanced sensory loss or proprioceptive impairment that could affect participation in the intervention
  • Botulinum toxin injection within the previous 3 months

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: Double

Arms and Interventions

Participant Group / Arm

Participant Group / Arm

A group or subgroup of participants in a clinical trial that receives a specific intervention/treatment, or no intervention, according to the trial's protocol.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Experimental: Multicomponent rotation training
Participants received 30 minutes of conventional physiotherapy and 15 minutes of sequential laterality, motor imagery, and mental rotation training, three times per week for six weeks.
Other: Laterality, Motor Imagery, and Mental Rotation Training
Participants received 30 minutes of conventional physiotherapy followed by 15 minutes of structured training, three times per week for six weeks. The training progressed sequentially through laterality recognition, motor imagery, and mental rotation. Laterality training involved identifying right- and left-hand images. Motor imagery training involved imagining the hand positions and movements shown in the images without performing an observable movement. Mental rotation training involved mentally rotating figures and selecting the correct response.
Sham Comparator: Sham training
Participants received 30 minutes of conventional physiotherapy and 15 minutes of active visual-attention training using neutral objects, colors, shapes, and symbols, three times per week for six weeks.
Other: Active Visual-Attention Control Training
Participants received 30 minutes of conventional physiotherapy followed by 15 minutes of active visual-attention control training, three times per week for six weeks. The training included images of neutral objects, colors, geometric shapes, and symbols that did not depict body parts. Participants classified the images according to color, shape, size, position, or similarity and difference.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
The Purdue Spatial Visualization Test
Time Frame: Baseline and immediately after the 6-week intervention.
The Purdue Spatial Visualization Test a widely used mental rotation tests, consists of 30 three-dimensional spatial perception questions.
Baseline and immediately after the 6-week intervention.

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
The Symbol Digit Modalities Test
Time Frame: Baseline and immediately after the 6-week intervention.
The Symbol Digit Modalities Test is a widely used assessment tool for measuring information-processing speed in patients with MS.
Baseline and immediately after the 6-week intervention.
Nine-Hole Peg Test
Time Frame: Baseline and immediately after the 6-week intervention.
In the Nine-Hole Peg Test, nine wooden pegs were placed into a wooden board containing nine holes using one hand.
Baseline and immediately after the 6-week intervention.
Kinesthetic and Visual Imagery Questionnaire
Time Frame: Baseline and immediately after the 6-week intervention.
Motor imagery ability was evaluated and scored using 20 items examining movements of different body parts in a sitting position, with two subscales assessing kinesthetic and visual imagery abilities. The total score ranges from 10 to 50, with each subscale ranging from 5 to 25.
Baseline and immediately after the 6-week intervention.
Grip Strength
Time Frame: Baseline and immediately after the 6-week intervention
Grip strength was assessed using a Jamar hand dynamometer.
Baseline and immediately after the 6-week intervention
Abilhand
Time Frame: Baseline and immediately after the 6-week intervention.
Abilhand is a patient-reported scale used to determine the perceived level of difficulty individuals experience when using their hands during activities of daily living. The Abilhand total raw score ranges from 0 to 46, with higher scores indicating better self-perceived manual ability in performing daily bimanual activities.
Baseline and immediately after the 6-week intervention.
The Action Research Arm Test (ARAT)
Time Frame: Baseline and immediately after the 6-week intervention.
The Action Research Arm Test was used to evaluate upper extremity functional capacity and consists of four subdomains: grasp, grip, pinch, and gross movement.
Baseline and immediately after the 6-week intervention.

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Abant Izzet Baysal University

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Enes Tayyip Benli, phd, Abant Izzet Baysal University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
February 15, 2024

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
January 15, 2026

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
February 15, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
July 30, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 5, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
August 6, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
August 6, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 5, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
August 1, 2026

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • AIBU-FTR-BENLI-010

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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