Motor Imagery Training in Persons With Multiple Sclerosis

The Effect of Telerehabilitation Based Motor Imagery Training on Gait and Balance Performance of the Persons With Multiple Sclerosis: A Randomized Controlled Trial

Motor imagery training facilitates the neural plasticity with increasing the neuronal cortical pathways in the brain. Motor imagery training is an effective way in stroke survivors. However, its effects in persons with multiple sclerosis (MS) are not known. Additionally, telerehabilitation based motor imagery training is very rare treatment way which requires more research. Therefore, this study aims to investigate the effect of telerehabilitation based motor imagery training on gait and balance performance of the persons with MS.

The participants will be allocated into three groups, including motor imagery training, wait-list control group, and healthy control group.

All the assessments will be performed before and after the training in the 8-week motor imagery training group. The participants in the control group will underwent the assessment with a 8-week interval. The healthy participants will be assessed only one.

The motor imagery training will be designed for the individual basis with following standard protocols. It will be applied two times a week for 8 weeks. The first one and/or two sessions will be performed in the clinic, the other will be performed at the patients' home with a video-conference telerehabilitation technique.

Study Overview

• Status: Completed
• Conditions: Multiple Sclerosis
• Intervention / Treatment: Other: Motor imagery training

Detailed Description

Multiple sclerosis (MS) is a chronic, inflammatory, and demyelinating disease of the central nervous system. It is the most common neurological disease which causes progressive gait and balance disorders in young adults. The previous studies have indicated that home care and treatment services, which accelerates the healing process and makes the one feel better, are more preferred by the patients. Persons with MS are commonly not able to access the institutional rehabilitation services because of their disability and/or home location. It restricts the participation of the persons with MS and their treatment benefits. In recent years, the telerehabilitation programs are increasing to overcome this problem. Motor imagery training also stands as a good option in the rehabilitation programs. Motor imagery is a mental process by which an individual rehearses or simulates a given action. Motor imagery training facilitates the neural plasticity with increasing the neuronal cortical pathways in the brain. Motor imagery training is an effective way in stroke survivors. However, its effects in persons with MS are not known. Additionally, telerehabilitation based motor imagery training is very rare treatment way which requires more research.

The aim of this study is to investigate the effect of telerehabilitation based motor imagery training on gait and balance performance of the persons with MS.

The participants will be allocated into three groups, including motor imagery training group, control group, and healthy control group. The persons with MS will be recruited from the outpatient MS clinic of Dokuz Eylul University, and the healthy participants will be recruited from the stuff of Dokuz Eylul University.

The inclusion and exclusion criteria assessments and the neurological examination will be performed by a blinded neurologist specialized in MS. The cognition, fatigue, depression, and quality of life assessment will be performed by a blinded neuropsychologist. The remaining assessments, including walking, balance, and motor imagery abilities will be assessed by a blinded physiotherapist. All the assessments will be performed before and after the training in the 8-week motor imagery training group. The participants in the control group will underwent the assessment with a 8-week interval. The healthy participants will be assessed only one.

The motor imagery training will be designed for the individual basis with following standard protocols. It will be applied two times a week for 8 weeks. The first one and/or two sessions will be performed in the clinic, the other will be performed at the patients' home with a video-conference telerehabilitation technique.

• Study Type: Interventional
• Enrollment (Actual): 70
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Izmir, Turkey, 35430
    • Dokuz Eylul University Hospital, MS Outpatient Clinic
  • Izmir, Turkey, 35430
    • Dokuz Eylul University, School of Physical Therapy and Rehabilitation

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Diagnosis of multiple sclerosis
• Having the Expanded Disability Status Scale 0 - 4.0
• Relapse-free period at the last 3 months
• Enough computer use ability
• Having computer and internet connection

Exclusion Criteria:

• Having severe musculoskeletal, cardiovascular, pulmonary, or metabolic disease
• Severe cognitive impairment
• Pregnancy

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Motor imagery training; Persons with multiple sclerosis	Other: Motor imagery training; The motor imagery training will be designed for the individual basis with following standard protocols. It will be applied two times a week for 8 weeks. The first one and/or two sessions will be performed in the clinic, the other will be performed at the patients' home with a video-conference telerehabilitation technique.
No Intervention: Control group; Persons with multiple sclerosis
No Intervention: Healthy controls; Healthy participants

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Dynamic Gait Index	Change from Baseline at 8 weeks

Secondary Outcome Measures

Outcome Measure	Time Frame
Timed 25-Foot Walk	Change from Baseline at 8 weeks
Curl-up Test	Change from Baseline at 8 weeks
Symbol Digit Modalities Test	Change from Baseline at 8 weeks
Expanded Disability Status Scale	At Baseline
Kinesthetic and Visual Imagery Questionnaire (KVIQ)-10	Change from Baseline at 8 weeks
Movement Imagery Questionnaire-Revised Second Edition (MIQ-RS)	Change from Baseline at 8 weeks
Mental Chronometry for 2-Meter Walk Test	Change from Baseline at 8 weeks
Mental Chronometry for 5-Meter Walk Test	Change from Baseline at 8 weeks
Mental Chronometry for 10-Meter Walk Test	Change from Baseline at 8 weeks
Mental Chronometry for Timed 25-Foot Walk	Change from Baseline at 8 weeks
Mental Chronometry for Timed Up and Go Test	Change from Baseline at 8 weeks
Mental Chronometry for Five Times Sit to Stand Test	Change from Baseline at 8 weeks
2-Meter Walk Test	Change from Baseline at 8 weeks
5-Meter Walk Test	Change from Baseline at 8 weeks
10-Meter Walk Test	Change from Baseline at 8 weeks
2-Minute Walk Test	Change from Baseline at 8 weeks
Twelve Item MS Walking Scale	Change from Baseline at 8 weeks
Timed Up and Go Test	Change from Baseline at 8 weeks
Five Times Sit to Stand Test	Change from Baseline at 8 weeks
Activities-specific Balance Confidence Scale	Change from Baseline at 8 weeks
Postural Stability Test by Balance System™	Change from Baseline at 8 weeks
The Limits of Stability Test by Balance System™	Change from Baseline at 8 weeks
Fall Risk Test by Balance System™	Change from Baseline at 8 weeks
Modified Fatigue Impact Scale	Change from Baseline at 8 weeks
Hospital Anxiety and Depression Scale	Change from Baseline at 8 weeks
Multiple Sclerosis International Quality of Life Questionnaire	Change from Baseline at 8 weeks
Selective Reminding Test	Change from Baseline at 8 weeks
10/36 Spatial Recall Test	Change from Baseline at 8 weeks

Collaborators and Investigators

• Sponsor: Dokuz Eylul University
• Investigators: Study Director: Sema Savci, Prof, PhD, Dokuz Eylul University; Principal Investigator: Turhan Kahraman, MSc, Dokuz Eylul University

Study record dates

Study Major Dates

• Study Start (Actual): May 1, 2016
• Primary Completion (Actual): October 1, 2017
• Study Completion (Actual): November 1, 2017

Study Registration Dates

• First Submitted: May 17, 2016
• First Submitted That Met QC Criteria: May 19, 2016
• First Posted (Estimate): May 24, 2016

Study Record Updates

• Last Update Posted (Actual): April 3, 2018
• Last Update Submitted That Met QC Criteria: March 30, 2018
• Last Verified: March 1, 2018

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Autoimmune Diseases; Multiple Sclerosis; Sclerosis
• Other Study ID Numbers: 2628-GOA

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No