Mental Rotation and Motor Imagery Training in Multiple Sclerosis

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: Completed
• Conditions: Relapsing Remitting MS (RRMS)
• Intervention / Treatment: Other: Laterality, Motor Imagery, and Mental Rotation Training; Other: Active Visual-Attention Control Training

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: Interventional
• Enrollment (Actual): 54
• Phase: Not Applicable

Contacts and Locations

Study Locations

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

Participation Criteria

Eligibility Criteria

• 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

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
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

Outcome Measure	Measure Description	Time Frame
The Purdue Spatial Visualization Test	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

Outcome Measure	Measure Description	Time Frame
The Symbol Digit Modalities Test	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	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	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	Grip strength was assessed using a Jamar hand dynamometer.	Baseline and immediately after the 6-week intervention
Abilhand	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)	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

• Sponsor: Abant Izzet Baysal University
• Investigators: Principal Investigator: Enes Tayyip Benli, phd, Abant Izzet Baysal University

Study record dates

Study Major Dates

• Study Start (Actual): February 15, 2024
• Primary Completion (Actual): January 15, 2026
• Study Completion (Actual): February 15, 2026

Study Registration Dates

• First Submitted: July 30, 2026
• First Submitted That Met QC Criteria: August 5, 2026
• First Posted (Actual): August 6, 2026

Study Record Updates

• Last Update Posted (Actual): August 6, 2026
• Last Update Submitted That Met QC Criteria: August 5, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Musculoskeletal and Neural Physiological Phenomena; Nervous System Physiological Phenomena; Dominance, Cerebral; Functional Laterality
• Other Study ID 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