1,721,013 research outputs found
The effect of a telerehabilitation virtual reality intervention on functional upper limb activities in people with multiple sclerosis: a study protocol for the TEAMS pilot randomized controlled trial
Full text linkBackground: Approximately 60% of people with multiple sclerosis (PwMS) suffer from upper limb dysfunction. Our primary goal is to implement a single-blind, randomized control trial (RCT) designed to compare the effectiveness of an 8-week home-based telerehab virtual reality (VR) program with conventional therapy in PwMS with manual dexterity difficulties. Secondary aims include (a) evaluating the impact of the programs on quality of life after the intervention and a follow-up 1 month later and (b) evaluating the impact of the programs on adherence and satisfaction.
Methods: Twenty-four PwMS will be recruited to the study which will be conducted at two established MS centers: (1) The Regional Center for Diagnosis and Treatment of Multiple Sclerosis, Binaghi Hospital, Cagliari, Italy, and (2) The Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Israel. Participants will complete a total of three assessments focusing on upper limb functions. Both groups will receive 16 training sessions focusing on functional upper limb activities. The home-based telerehab VR intervention will comprise a custom-made software program running on a private computer or laptop. PwMS will perform several activities of daily living (ADL) functions associated with self-care, dressing, and meal preparation. Conventional therapy will focus on task-related upper-limb treatments while in a sitting position, indicative of the standard care in MS. Following 8 weeks of training, participants will complete a further outcome assessment. The same tests will be conducted 1 month (as a follow-up) after completion of the intervention.
Discussion: The outcomes of this study have tremendous potential to improve the quality of evidence and informed decisions of functional upper limb activities in PwMS. If comparable results are found between the treatments in improving upper limb outcomes, this would suggest that PwMS can choose the program that best meets their personal needs, e.g., financial concerns, transportation, or accessibility issues. Secondly, this information can be used by healthcare providers and medical professionals in developing upper limb exercise programs that will most likely succeed in PwMS
An AI-Based Telerehabilitation Solution to Improve Mobility in People With Multiple Sclerosis: Protocol for an Implementation and Evaluation Study (The PLATINUMS Project) (Preprint)
No full textBackground: Multiple sclerosis (MS) is a chronic, progressive, and neurodegenerative disease affecting more than 2.8 million people globally. Mobility impairments are among the most significant challenges faced by people with MS, leading to physical inactivity, deconditioning, and disability progression (for some, even irreversible disability). This negatively impacts mental health, social participation, and quality of life while placing a considerable economic burden on society. Exercise can improve mobility and mitigate disability progression, but facility-based options are often inaccessible, especially for those in remote areas. Telerehabilitation offers a promising alternative, but current systems are limited by complexity and hardware requirements. Objective: The PLATINUMS (Implementation of an Advanced Telerehabilitation Solution for People With Multiple Sclerosis) project proposes an AI-driven telerehabilitation system to deliver accessible, cost-effective, and home-based exercise therapy for people with MS. Methods: The PLATINUMS project begins with working package (WP) 1, focusing on obtaining ethical approval and recruiting staff. Following this, WP2 involves a 4-week system feasibility and usability study (n=40) to assess and refine the digital platform. WP3 comprises a validity study (n=60) to evaluate remote mobility tests via the system, such as the Short Physical Performance Battery (SPPB), functional reach, and sit-to-stand tests, to ensure their reliability for use in WP4, the feasibility multicenter randomized controlled trial (RCT). The 10-week multicenter feasibility RCT will be conducted in MS centers across Denmark, Ireland, Israel, and Italy, with 96 participants varying in disability levels. The primary objective is to evaluate the efficacy of the AI-powered telerehabilitation system on mobility outcomes compared to usual care. Finally, WP5 will assess the cost-effectiveness of the telerehabilitation system by analyzing implementation costs, adherence, and use of health care. The PLATINUMS project aims to revolutionize exercise therapy for people with MS by demonstrating the feasibility, validity, and preliminary efficacy of the AI-driven telerehabilitation system. This approach addresses barriers such as accessibility, privacy, and standardization while promoting patient and therapist acceptance. Results: Funding for the PLATINUMS project was obtained in February 2024. WP2 data collection began in April 2025 across 4 European sites. WP3 is scheduled to launch in July 2025, with WP4 (the feasibility RCT) planned for January 2026. Initial WP2 results are expected by October 2025, with first publications anticipated in mid-2026. Conclusions: The PLATINUMS project is expected to generate critical insights into the feasibility, usability, and preliminary efficacy of an AI-based telerehabilitation system for people with MS. By leveraging widely available technology and real-time feedback, the system addresses key barriers to traditional rehabilitation. Findings from this protocol may inform future large-scale trials and support the broader implementation of digital health solutions in neurological rehabilitation. International registered report identifier (irrid): PRR1-10.2196/75983
Effects of prolonged walking on dual-task walking performance in persons with multiple sclerosis
No full textObjective: Motor impairment and fatigue perception may affect walking automaticity. We aimed to investigate the effect of prolonged walking administered by the 6-Minute Walk Test (6MWT) on motor-cognitive dual-task performance in persons with multiple sclerosis (pwMS) with different levels of disability compared to healthy controls (HC). Methods: A total of 50 pwMS [30 mildly disabled (EDSS<4.0), 20 moderately-severely disabled (EDSS 4.0 to 6.5)] and 29 age-and sex-matched HC were included. Spatiotemporal gait parameters during single (overground walking for 30 sec) and dual-task walking (overground walking for 30 sec with word list generation task) were assessed before and immediately after the 6MWT using three inertial gait sensors. The dual-task cost (DTC) of gait parameters was calculated as change (in percentage) between the dual-task to the single-task conditions. Perceived walking difficulties , fatigue, history of falls, fear of falling, and perceived dual-task difficulties were evaluated via self-report questionnaires. Results: PwMS with moderate-to-severe disability group had a significant deterioration in cadence, speed, double support, and asymmetry during dual-task walking after the 6MWT. However, there was no change in mildly disabled pwMS, and HC demonstrated better scores in cadence, speed, and gait variability after the 6MWT. As for the DTC, while mildly disabled pwMS (in speed and gait variability) and HC (in double support, cadence, and gait variability) showed improvements, no significant difference was found in moderate to severely disabled pwMS. Cognitive task performance incremented solely in HC following the 6MWT. Change in DTC was correlated to self-reported walking disability, fatigue, and perceived dual-task difficulties (r =-0.301 to-0.337) in pwMS. Conclusion: Prolonged walking affects severely disabled pwMS regardless of the cognitive task. This suggests that they focus more on walking than cognitive task performance. Mildly disabled pwMS and HC could maintain gait automatization and even reduce DTC after 6MWT, suggesting that 6MWT may not be sufficient to induce performance fatigability as measured by dual-task performance in mildly disabled pwMS and may even make gait more dynamic. Progressive multifocal encephalopathy (PML) is a potentially fatal opportunistic infection of the central nervous system by John Cuningham virus. We report on a multidisciplinary rehabilitation in a 45-year-old female suffering from PML after 20 natalizumab infusions. After natalizumab discontinuation immune reconstitution inflammatory syndrome (IRIS) developed leading to additional deterioration of the neurological disability of the patient. Initial right sided hemiparesis slowly progressed to hemiplegia, later left sided hemipa-resis appeared as well as motoric dysphasia so she became bedridden and completely dependent in activities of daily living (ADL). Physiotherapy treatment focused on deterioration of posture control , sensorimotor skills of the right-sided limbs and gait pattern. Exercises for postural stability and movement control were performed. Occupational therapy (OT) focused on maintaining ADL, underlying fatigue and sensory-motor impairment in right upper limb. After the deterioration of her health condition, physiotherapists implemented gradual verticalization and bed-wheelchair transfer. OT then focused on body positioning and impairments in both upper limbs, along with improving attitude to her current life situation. Clinical psychologist was included to provide psychological support and improve communication. We used basic cogni-tive behavioural model, relaxation techniques, normalisation, guided imagery for stress relief and regulation of mood. Speech language pathologist treatment was indicated when deviations in the quality and intelligibility of speech and communication appeared. Communication was maintained through closed-ended, dichotomous questions. With the progression of speech apraxia, the Augmentative and Alternative Communication board was introduced. Apraxia of speech persists at the forefront and significantly disables the patient in everyday communication. Multidisciplinary rehabilitation was essential in maintaining patient's functional level, preventing further decline as well as helping the neurologist monitor disease progression of her primary diagnosis as well as IRIS and in this way influence further diagnostic and therapeutic decisions
Effects of prolonged walking on dual-task walking performance in persons with multiple sclerosis
No full textObjective: Motor impairment and fatigue perception may affect walking automaticity. We aimed to investigate the effect of prolonged walking administered by the 6-Minute Walk Test (6MWT) on motor-cognitive dual-task performance in persons with multiple sclerosis (pwMS) with different levels of disability compared to healthy controls (HC). Methods: A total of 50 pwMS [30 mildly disabled (EDSS<4.0), 20 moderately-severely disabled (EDSS 4.0 to 6.5)] and 29 age-and sex-matched HC were included. Spatiotemporal gait parameters during single (overground walking for 30 sec) and dual-task walking (overground walking for 30 sec with word list generation task) were assessed before and immediately after the 6MWT using three inertial gait sensors. The dual-task cost (DTC) of gait parameters was calculated as change (in percentage) between the dual-task to the single-task conditions. Perceived walking difficulties , fatigue, history of falls, fear of falling, and perceived dual-task difficulties were evaluated via self-report questionnaires. Results: PwMS with moderate-to-severe disability group had a significant deterioration in cadence, speed, double support, and asymmetry during dual-task walking after the 6MWT. However, there was no change in mildly disabled pwMS, and HC demonstrated better scores in cadence, speed, and gait variability after the 6MWT. As for the DTC, while mildly disabled pwMS (in speed and gait variability) and HC (in double support, cadence, and gait variability) showed improvements, no significant difference was found in moderate to severely disabled pwMS. Cognitive task performance incremented solely in HC following the 6MWT. Change in DTC was correlated to self-reported walking disability, fatigue, and perceived dual-task difficulties (r =-0.301 to-0.337) in pwMS. Conclusion: Prolonged walking affects severely disabled pwMS regardless of the cognitive task. This suggests that they focus more on walking than cognitive task performance. Mildly disabled pwMS and HC could maintain gait automatization and even reduce DTC after 6MWT, suggesting that 6MWT may not be sufficient to induce performance fatigability as measured by dual-task performance in mildly disabled pwMS and may even make gait more dynamic. Progressive multifocal encephalopathy (PML) is a potentially fatal opportunistic infection of the central nervous system by John Cuningham virus. We report on a multidisciplinary rehabilitation in a 45-year-old female suffering from PML after 20 natalizumab infusions. After natalizumab discontinuation immune reconstitution inflammatory syndrome (IRIS) developed leading to additional deterioration of the neurological disability of the patient. Initial right sided hemiparesis slowly progressed to hemiplegia, later left sided hemipa-resis appeared as well as motoric dysphasia so she became bedridden and completely dependent in activities of daily living (ADL). Physiotherapy treatment focused on deterioration of posture control , sensorimotor skills of the right-sided limbs and gait pattern. Exercises for postural stability and movement control were performed. Occupational therapy (OT) focused on maintaining ADL, underlying fatigue and sensory-motor impairment in right upper limb. After the deterioration of her health condition, physiotherapists implemented gradual verticalization and bed-wheelchair transfer. OT then focused on body positioning and impairments in both upper limbs, along with improving attitude to her current life situation. Clinical psychologist was included to provide psychological support and improve communication. We used basic cogni-tive behavioural model, relaxation techniques, normalisation, guided imagery for stress relief and regulation of mood. Speech language pathologist treatment was indicated when deviations in the quality and intelligibility of speech and communication appeared. Communication was maintained through closed-ended, dichotomous questions. With the progression of speech apraxia, the Augmentative and Alternative Communication board was introduced. Apraxia of speech persists at the forefront and significantly disables the patient in everyday communication. Multidisciplinary rehabilitation was essential in maintaining patient's functional level, preventing further decline as well as helping the neurologist monitor disease progression of her primary diagnosis as well as IRIS and in this way influence further diagnostic and therapeutic decisions
Real-time cortical activity during virtual reality practice in people with multiple sclerosis: a pilot fNIRS study
Full text linkBackground: Multiple sclerosis (MS) is a neuroinflammatory disorder affecting motor and cognitive functions. Virtual reality (VR) is increasingly used in rehabilitation, offering controlled environments for motor training and for integrating cognitive challenges into physical tasks through dual-task paradigms. Functional near-infrared spectroscopy (fNIRS) is a promising tool for assessing cortical activation in VR-based rehabilitation, yet its application in people with MS (pwMS) remains underexplored. This study aimed to examine cortical activation in pwMS during an upper-limb daily life activity performed in VR versus actual performance (AP), and to assess the additional impact of an explicit cognitive challenge implemented as a memory recall and sequencing task performed simultaneously with the motor activity. Methods: A pilot fNIRS case-control study was conducted with 14 pwMS and 14 healthy controls, matched for age and sex. Participants completed a dishwashing task under four conditions: (1) VR, (2) VR with a cognitive challenge (VR-cog), (3) AP, and (4) AP with a cognitive challenge (AP-cog). fNIRS measured relative changes in the concentrations of oxyhemoglobin (ΔHbO), deoxyhemoglobin (ΔHbR), and total hemoglobin (ΔHbT) in the supplementary motor area (SMA), premotor cortex (PMC), and somatosensory association cortex (SAC). A general linear model and repeated-measures ANOVA assessed cortical activation across conditions. Results: PwMS exhibited reduced ΔHbT concentrations in the SMA and PMC compared to healthy controls during both VR and AP tasks (p = 0.019 and p = 0.038, respectively), suggesting diminished neurovascular activation. Within-group analyses revealed significant task-dependent modulation in healthy controls, with greater neurovascular responses in the SMA and PMC. In contrast, pwMS showed no significant differences in cortical activation across task conditions, indicating impaired neurovascular adaptability. No significant differences between groups were observed in the VR-cog and AP-cog conditions, suggesting that the cognitive challenge did not further differentiate neurovascular responses. Conclusions: While no significant differences in overall cortical activation were found between VR and real-world tasks, pwMS exhibited reduced neurovascular responses compared to healthy controls, indicating impaired adaptability. These findings support VR's feasibility for motor rehabilitation while highlighting the need for further studies on neuroplasticity, cognitive-motor integration, and lesion-related neurovascular changes in pwMS
Patient-Reported Outcome Measures for Assessing Dual-Task Performance in Daily Life: A Review of Current Instruments, Use, and Measurement Properties
No full textThe patient perspective of dual-task (DT) impairment in real life is unclear. This review aimed (i) to identify patient-reported outcome measures (PROMs) on DT and evaluate their measurement properties and (ii) to investigate the usage of PROMs for the evaluation of DT difficulties. A systematic literature search was conducted using PubMed and Web of Science from inception to March 2022. Methodological quality was evaluated using the COSMIN checklist. Six studies examined the measurement properties of DT PROMs. Nine studies used DT PROMs as the outcome measure. Five PROMs were identified, including the Divided Attention Questionnaire (DAQ), Dual-Task-Impact on Daily-life Activities Questionnaire (DIDA-Q), a Questionnaire by Cock et al. (QOC), Dual-Tasking Questionnaire (DTQ), and Dual-Task Screening-List (DTSL). Fourteen measurement properties were documented: five (35.7%) rated quality as “sufficient”, six (42.8%) “insufficient”, and three (21.4%) “indeterminate”. The quality of evidence for each measurement property ranged from very low to high. While DT performance is investigated in many populations, the use of PROMs is still limited, although five instruments are available. Currently, due to insufficient data, it is not possible to recommend a specific DT PROM in a specific population. An exception is DIDA-Q, which has the highest quality of measurement properties in people with multiple sclerosis
Walking but not cognitive fatigability measurement is reliable in moderate to severe multiple sclerosis patients
No full textAims: The aim of our research is to check the validity, the reliability and the responsiveness of those two tests in Multiple Sclerosis, since we believe that they are very feasible tools in MS walking assessment. Methods: pwMS with EDSS ⩽6.5, followed as outpatients at the AISM rehabilitation center of Genoa, were enrolled in the study. We performed a correlation of the two scales with the AI and the EDSS scale, considered a gold standard scale for people with MS (pwMS); a test-retest was administered by another operator and a comparison between the first evaluation and the last one after ten/ twelve sessions of physiotherapy. Results: We collected the preliminary data of 30pwMS (12 M/18 F, EDSS range 1.5-6.5). In our results, EDSS correlates significantly with 30SCST (p<0.0001) and FTSST (p<0.0078) and AI also correlates significantly with both (30SCT p<0.0001; FTSST p<0.0001). The test-retest analysis shows a very high correlation between the two evaluations (r Pearson 0.9408) and Cronbach's alpha is 0.989. Furthermore, both 30SCST and FTSST shows a great responsiveness to a physiotherapy treatment (30SCST p<0.0003, FTSST p<0.0001). Conclusion: Data suggest that 30SCST and FTSST seem to be valid and reliable tools. Moreover, they are probably responsive to change. In conclusion, these two tests are simple, reliable, safe and easy to administer
Walking but not cognitive fatigability measurement is reliable in moderate to severe multiple sclerosis patients
No full textAims: The aim of our research is to check the validity, the reliability and the responsiveness of those two tests in Multiple Sclerosis, since we believe that they are very feasible tools in MS walking assessment. Methods: pwMS with EDSS ⩽6.5, followed as outpatients at the AISM rehabilitation center of Genoa, were enrolled in the study. We performed a correlation of the two scales with the AI and the EDSS scale, considered a gold standard scale for people with MS (pwMS); a test-retest was administered by another operator and a comparison between the first evaluation and the last one after ten/ twelve sessions of physiotherapy. Results: We collected the preliminary data of 30pwMS (12 M/18 F, EDSS range 1.5-6.5). In our results, EDSS correlates significantly with 30SCST (p<0.0001) and FTSST (p<0.0078) and AI also correlates significantly with both (30SCT p<0.0001; FTSST p<0.0001). The test-retest analysis shows a very high correlation between the two evaluations (r Pearson 0.9408) and Cronbach's alpha is 0.989. Furthermore, both 30SCST and FTSST shows a great responsiveness to a physiotherapy treatment (30SCST p<0.0003, FTSST p<0.0001). Conclusion: Data suggest that 30SCST and FTSST seem to be valid and reliable tools. Moreover, they are probably responsive to change. In conclusion, these two tests are simple, reliable, safe and easy to administer
Changes in Gait Characteristics During and Immediately After the 6-Minute Walk Test in Persons With Multiple Sclerosis: A Systematic Review.
No full textObjective There is limited information about gait patterns during prolonged walking in people with multiple sclerosis (PwMS). The aim of this review was to report on gait metrics during and immediately after the 6-Minute Walk Test (6MWT) in PwMS with different levels of disability. Methods The systematic search was performed in 3 databases (PubMed, Web of Science, and SCOPUS) using keywords related to multiple sclerosis and 6MWT. Studies that reported on quantitative gait outcomes before and after the 6MWT or multiple time points during the 6MWT were included. The Hedges g effect size (ES) was calculated to determine the magnitude of change in each gait parameter. Results Fourteen studies (n = 534 PwMS; n = 166 healthy controls) were eligible. Five studies investigated gait parameters prior to and immediately after the 6MWT. Nine studies collected gait measures during the 6MWT. Speed (ES = -0.43 to 0.19), cadence (ES = -0.46 to 0.16), step length (ES = -0.46 to 0.14), stability (ES = -0.35 to 0.33), and regularity (ES = -0.25 to -0.15) decreased in most studies. In the majority of included studies, step time (ES = 0 to 0.35), stance period (ES = 0.12 to 0.58), double support phase (ES = 0.03 to 0.62), variability (ES = -0.19 to 1.13), and asymmetry (ES = -0.79 to 0.62) increased following the 6MWT. The kinetic and kinematic (mainly in dorsiflexion angle [ES = -0.08 to -0.36]) features of gait were also negatively changed after 6 minutes of walking. Walking speed, cadence, step length, stride length, and stride time after 6MWT at a comfortable speed all increased. Changes in the majority of spatiotemporal parameters were more pronounced in PwMS with moderate-to-severe disability compared with PwMS with mild disability. Conclusion Most quantitative gait parameters deteriorated during the 6MWT, especially in PwMS with moderate-to-severe disability. Impact The deterioration of gait patterns should be considered when designing therapeutic interventions to increase sustained walking capacity.This study was supported by a grant from Hasselt University – Special Research Fund under grant number BOF20BL13
Sustained Attention and Gait Pattern Changes during the 6-minute Walk Test in Persons with Multiple Sclerosis
No full textBackground and purpose: It is unknown whether persons with multiple sclerosis (pwMS) can retain sustained attention and gait quality during long-distance walking tests. This study aimed to investigate changes in sustained attention and gait parameters during prolonged walking in pwMS with different levels of disability and healthy controls (HCs) and correlations of these changes with self-reported daily life difficulties. Methods: The 6-Minute Walk Test was performed with an auditory sustained attention task while wearing inertial measurement sensors. Participants were asked to respond verbally as quickly as possible to randomly presented auditory stimuli during 6 minutes of walking. The accuracy of answers, average reaction time, and gait parameters per minute were determined. Results: Thirty pwMS with mild disability (Expanded Disease Status Scale [EDSS] < 4.0), 16 pwMS with moderate-to-severe disability (EDSS 4.0 to 6.5), and 27 age-gender matched HCs were included. A significant group-by-time interaction effect as found for reactions times, which increased in mild and moderate-to-severe disability groups but not in HCs. Gait parameters deteriorated over time in all groups, but no significant group-by-time interaction was found. The decrease in sustained attention was not related to changes in gait or clinical outcomes, while deterioration in gait parameters was associated with perceived walking disability and dual-task difficulties in daily life. Discussion and Conclusions: Sustained attention during walking declined over time in pwMS, but not in HCs. However, gait parameters deteriorated in all groups. Worsening gait during simultaneous cognitive task execution may contribute to walking and dual-task difficulties in pwMS. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A520
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