Combined Motor Imagery and Vestibular Rehab for MS (MIVR-MS)

April 26, 2026 updated by: Gehad Salem Mohamed Mohamed Menshawi, Medipol University

The Effectiveness of Combination of Motor Imagery and Vestibular Rehabilitation on Balance, Cognition, and Quality of Life in Patients With Multiple Sclerosis

This trial investigates the first combined use of motor imagery and vestibular rehabilitation in multiple sclerosis, aiming to evaluate their joint effect on balance, cognition, and quality of life.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

Detailed Description

Multiple sclerosis often causes balance disturbance, cognitive decline, and reduced quality of life. Motor imagery and vestibular rehabilitation are established methods in MS care, but their effects have only been studied separately. This randomized controlled trial introduces a combined program of motor imagery and vestibular training to explore whether their integration provides broader benefits. The study will recruit patients with relapsing-remitting MS, apply an 8-week intervention, and compare outcomes in cognition, balance, physical performance, and quality of life against conventional therapy.

Study Type

Interventional

Enrollment (Estimated)

30

Phase

  • 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 Contact

  • Name: Gehad Salem menshawi, PT, MSc (Cand.)
  • Phone Number: +905524590178 +201040131964
  • Email: j.menshawi@hotmail.com

Study Contact Backup

Study Locations

  • Turkey (Türkiye)
    • Beykoz/İstanbul
      • Istanbul, Beykoz/İstanbul, Turkey (Türkiye), 34810
        • Recruiting
        • Gehad Salem Mohamed Mohamed Menshawi
        • Contact:
        • Contact:
        • Principal Investigator:
          • gehad menshawi, MSc (Cand.)

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

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

No

Description

inclusion criteria

  1. Diagnosis of Multiple Sclerosis (MS) Confirmed using McDonald Criteria
  2. Patient diagnosed relapsing-remitting multiple sclerosis (RRMS).
  3. Mild MS between 0-3 according to PDDS.
  4. Age from (18-45)
  5. Mild cognitive impairment
  6. Balance impairment (mild to moderate impairment)
  7. Vestibular dysfunction Related to MS (dizziness, vertigo , gaze instability ) 8. Native language is Arabic to ensure clear communication during cognitive tasks and exercise instructions

9. Be able to joined the treatment (motor imagery, vestibular rehabilitaiton )

Exclusion Criteria:

Other neurological disorder, progressive multiple sclerosis Non-MS related vestibular disorders (e.g., BPPV, Meniere's disease) that would interfere with vestibular rehab.

Severe Psychiatric Conditions (schizophrenia, bipolar, etc) Sever balance disorder Sever fatigue Medical instability eg (cardiovascular disease, respiratory, infections, severe uncontrolled diabetes, or severe visual impairments.) Sever cognitive impairment Pregnant Advance disability ( wheelchair , unable to stand ) Use of Vestibular-Suppressing Medications Non - speaker Arabic

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
Intervention / Treatment
Experimental: Motor Imagery + Vestibular Rehabilitation Group
Participants receive a combined intervention of motor imagery and vestibular rehabilitation. Sessions last 55 minutes, including 5 min breathing warm-up, 20 min motor imagery training, 20 min vestibular exercises for balance and dizziness reduction, and 10 min cool-down/relaxation. The program aims to improve balance, cognitive function, and quality of life in patients with Multiple Sclerosis. Symptoms are monitored to avoid overexertion or symptom exacerbation.
Behavioral: Motor Imagery + Vestibular Rehabilitation group

This 8-week program, 3 sessions/week, 55- 60 min each, includes 4 steps:

Warm-up (5 min): Breathing exercises progressing from basic diaphragmatic and pursed-lip breathing (weeks 1-2), light movement with breathing (weeks 3-4), to Inspiratory Muscle Training device (weeks 5-8).

Motor Imagery (15 min): Foundational phase (weeks 1-2) imagining basic movements, skills building (weeks 3-4) with functional daily tasks, advanced phase (weeks 5-8) imagining complex tasks, environmental and cognitive challenges (e.g., sports, obstacle navigation, walking on uneven surfaces).

Vestibular Rehabilitation (15 min): Foundational (weeks 1-2) gaze stabilization and static balance (VOR, VSR, VCR), dynamic balance and dual-task exercises (weeks 3-6), advanced functional balance and vestibular-cognition integration (weeks 7-8).

Cool-down (10 min): Relaxation and symptom monitoring to prevent overexertion, dizziness, or fatigue.
Other: Conventional Group
Participants receive conventional care for Multiple Sclerosis, including routine medical follow-up and standard physiotherapy if applicable. No specific motor imagery or vestibular rehabilitation exercises are administered. This group serves as a comparison to evaluate the effects of the experimental intervention.
Behavioral: Conventional therapy group

This 8-week program, 3 sessions/week, 55- 60 min each, includes:

Warm-up: Seated/standing marching, neck and shoulder stretching.

Strength & Functional Movements: Sit-to-stand, side leg raises, step-ups.

Core & Upper Body: Bridge exercise, seated core activation, seated leg lifts, wall push-ups, seated shoulder press.

Flexibility & Balance: Calf and hamstring stretches, spinal flexibility, single-leg stance, lunges, tandem walking.

Cool-down: Deep breathing and gentle stretching.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Cognitive Function (Montreal Cognitive Assessment [MoCA] Score)
Time Frame: Baseline and 8 weeks after intervention

It is a cognitive screening tool commonly used in clinics and research to assess individual cognitive impairment and its severity. It helps therapists evaluate a patient's cognitive function and identify changes over time by assessing mental capacity functions and takes about 10-15 minutes to complete., which includes Attention & Concentration, Executive Functions, Memory, Language, Visuospatial Skills and Orientation (19).

  1. The test is scored out of 30 points.
  2. A score of 26 or higher is considered normal.
  3. Scores below 26 may indicate mild cognitive impairment or early dementia.
Baseline and 8 weeks after intervention
Change in Vestibular Function (Dynamic Visual Acuity [DVA] Test)
Time Frame: Baseline and Week 8.
DVA assesses visual acuity during head movement to evaluate vestibulo-ocular reflex integrity.It is a functional test designed to evaluate the integrity of the vestibulo-ocular reflex (VOR), which stabilizes the eyes during head motion. DVA is commonly employed to detect vestibular dysfunction and is particularly useful for evaluating vestibular function in patients experiencing dizziness, balance disorders, or conditions such as multiple sclerosis (MS), where vestibular dysfunction is common
Baseline and Week 8.
Change in Vestibular Function (Head Impulse Test [HIT])
Time Frame: Baseline and Week 8
Bedside assessment of semicircular canal/VOR function. Outcome recorded as presence/absence of corrective saccades and qualitative clinician rating of gain; improvement indicates better vestibular function.It is a clinical test used to identify deficits in the semicircular canals, especially the horizontal canal, and is useful for detecting peripheral vestibular deficits. It assesses the ability of the vestibulo-ocular reflex (VOR) to maintain stable vision during rapid, unpredictable head movements
Baseline and Week 8
Change in Cognitive Function (Brief International Cognitive Assessment for MS \[BICAMS] Composite Score
Time Frame: Baseline (Week 0) and Post-intervention (Week 8)
Cognition will be assessed using BICAMS (SDMT, CVLT-II, BVMT-R). A composite and subtest scores will be calculated; This test is valdiated in Egyption dialect. It is a specialized tool designed for patients with multiple sclerosis to assess their cognitive function. It is reliable, quick, and sensitive, making it useful for both clinical settings and research. The tool focuses on cognitive domains that are commonly affected in multiple sclerosis, such as memory, speed, and learning. It includes tests like the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test-II (CVLT-II), and Brief Visuospatial Memory Test-Revised (BVMT-R)
Baseline (Week 0) and Post-intervention (Week 8)
Change in balance (Timed Up and Go [TUG] Time)
Time Frame: Baseline and Week 8
Seconds to stand up, walk 3 m, turn, return, and sit. Lower times indicate better mobility; ≥12 s suggests increased fall risk.
Baseline and Week 8
Change in Disability Status (Patient-Determined Disease Steps \[PDDS] Score)
Time Frame: Baseline and Week 8.
Self-reported disability (0-8); higher scores indicate greater disability.
Baseline and Week 8.
Change in Balance Berg Balance Scale \[ABBS] Score)
Time Frame: Baseline (Week 0) and Post-intervention (Week 8)

To assess balance and fall risk in Arabic-speaking patients with neurological disorders, lower scores indicate more severe balance problems (23).

  1. 41-56: Low fall risk
  2. 21-40: Moderate fall risk.
  3. 0-20: High fall risk."
Baseline (Week 0) and Post-intervention (Week 8)

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Quality of Life (Multiple Sclerosis Impact Scale-29 \[MSIS-29]
Time Frame: Baseline and Week 8.
The Multiple Sclerosis Impact Scale-29 (MSIS-29) is a clinical tool used by patients to assess the impact of MS on their quality of life. The questionnaire consists of 29 questions and evaluates both physical and psychological well-being, helping to determine how MS affects daily life
Baseline and Week 8.

Collaborators and Investigators

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

Sponsor

Medipol University

Investigators

  • Study Director: Merve Yılmaz Menek, Assoc. Prof, Assoc. prof. Merve Yılmaz Menek

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Helpful Links

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)

December 1, 2025

Primary Completion (Estimated)

May 30, 2026

Study Completion (Estimated)

July 20, 2026

Study Registration Dates

First Submitted

September 23, 2025

First Submitted That Met QC Criteria

November 14, 2025

First Posted (Actual)

November 17, 2025

Study Record Updates

Last Update Posted (Actual)

April 30, 2026

Last Update Submitted That Met QC Criteria

April 26, 2026

Last Verified

November 1, 2025

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • E-10840098-202.3.02-1593

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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