Virtual Reality Versus Mental Practice On Balance And Gait In Patients With Multiple Sclerosis

The virtual environment presented via Head Mounted Display (HMD) has three-dimensional presentation and the panoramic view that covers the users' field of view, it facilitates immersion in the virtual and distraction from the real world

Mental Practice is among the recommended strategies to enhance performance. MP is a symbolic exercise, involving repeated mental imagery in the absence of any visible muscle contraction.

Dual tasking and Task oriented training in static and dynamic forms

spatial, temporal and angular parameters as cadence, step length and range of motion of hip, knee and ankle will be measured using software analysis "Kinovea" Kinovea is a free, open-source 2D video analysis software. It does not generate a single composite "score". Instead, it measures quantitative biomechanical and kinematic metrics from recorded video.

"10 minutes walk test" will be performed pre and post treatment by asking the patient to walk through a 12 meter walkway and calculate the time for 10 meters in tha walkway in two walking speeds( normal - fast) for 2 or 3 trials of each speed Speed > 1.2 m/s: Normal / Community AmbulatorAble to safely cross street intersections and navigate crowded environments.

0.8 - 1.2 m/s: Limited Community Ambulator/ Able to walk outdoors independently 0.4 - 0.8 m/s: Household Ambulator/ Mostly restricted to indoor walking; requires assistance or equipment outdoors.

< 0.4 m/s: Severe Functional Limitation

static and dynamic balance will be assessed using "Berg Balance Scale" The Berg Balance Scale (BBS) is a 14-item clinical assessment scale designed to measure static balance and dynamic functional mobility, Point Scale: Each of the 14 tasks is rated on a 0 to 4 ordinal scale based on safety, independence, time held, or distance reached, Scores are summed across all items for a overall score ranging from 0 to 56 points (higher scores reflect better balance and mobility).

"Timed Up and Go" test giving numerical data pre and post treatment about balance and risk of falling

Test is scored entirely by time (in seconds):

Time < 10 seconds: Normal / Completely IndependentFreely mobile; minimal to no fall risk 10 - 19 seconds: Mostly Independent, Reasonable balance and gait speed, generally low fall risk 20 - 29 seconds: Variable MobilityImpaired mobility, slower gait speed > 30 seconds: Severely Impaired, high fall risk