The Effect of Augmented Reality Based Telerehabilitation Application on Neuromuscular and Sensorimotor Parameters in Multiple Sclerosis Patients

Study Overview
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Brief Summary
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Core stability, which is affected from the early period in with patients Multiple Sclerosis (PwMS), is due to deterioration in the somatosensory, motor and musculoskeletal systems. Based on the knowledge that core stability is effective on many functions, it is seen that trunk stabilization exercises are included in the physiotherapy and rehabilitation programs of patients. However, the effectiveness of augmented reality-based telerehabilitation application, which includes trunk stabilization training in PwMS, has not been adequately investigated in the literature. The aim of the study is to investigate the effectiveness of augmented reality-based telerehabilitation application, which includes trunk stabilization training, on neuromuscular and sensorimotor parameters in PwMS.

Official Title
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The Effect of Augmented Reality Based Telerehabilitation Application on Neuromuscular and Sensorimotor Parameters in Multiple Sclerosis Patients

Conditions
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Multiple Sclerosis

Intervention / Treatment
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* Other: Augmented Reality Based Telerehabilitation Application
* Other: Training face-to-face


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosed with relapsing remitting MS by a neurologist, Having a disability level between 1 and 5 according to the Expanded Disability Status Scale (EDSS), Those who get over 24 points in the Standardized Mini Mental State Test (SMMT), Those who have not had an MS attack in the last three months, Volunteer individuals Exclusion Criteria: Receiving corticosteroid therapy in the last 4 weeks, Having additional neurological disease that may cause balance disorder Individuals who have had surgery related to the spine, hip, knee or ankle

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group 1<br>Patients in this group will receive spinal stabilization training through augmented reality based telerehabilitation application. | Other: Augmented Reality Based Telerehabilitation Application<br>* Spinal stabilization training with augmented reality-based telerehabilitation will be applied twice a week for 8 weeks.<br>|
| Active Comparator: Group 2<br>Patients in this group will receive spinal stabilization training face-to-face. | Other: Training face-to-face<br>* Spinal stabilization training will be applied face-to-face twice a week for 8 weeks.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Balance | MiniBESTest will be used to evaluate the static and dynamic balance.It consists of 14 questions including antisipatuar postural reaction, reactive postural control, sensory orientation and dynamic balance. The test is scored between 0-28 points. The highest score indicates good balance. | Change from baseline at 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Muscle Activity | An 8-channel superficial EMG system will be used to measure signals from the quadriceps and tibialis anterior muscles.Electrodes will be placed according to SENIAM criteria.The signals received from the muscles of the individuals will be recorded during standing up from sitting. As a result, the average muscle activations of the muscles during the activity will be numerically recorded in %MVIC. | Change from baseline at 8 weeks | 
| Core Muscle Endurance-Trunk Flexor | The trunk flexor test will be performed with the arms crossed over the thorax, the trunk at 60 degrees of flexion, and the knees and hips flexed to 90 degrees. The test will be finished when the participant is unable to maintain the position. The time will be recorded.As the time increases, the endurance decreases. | Change from baseline at 8 weeks | 
| Core Muscle Endurance- Trunk Extansor | The trunk extensor test will be performed in the prone position, with the pelvis, hips and knees fixed to the bed. The participant will be asked to cross his arms over his body and position his body horizontally. The test will be finished when the participant is unable to maintain the horizontal position. The time will be recorded. As the time increases, the endurance decreases. | Change from baseline at 8 weeks | 
| Core Muscle Endurance- Side Bridge | While the participants are in the side-lying position, they will raise their hips and align their bodies in a straight line by getting support from their feet and elbows. The time will be recorded by asking them to maintain the position as much as possible.As the time increases, the endurance decreases. | Change from baseline at 8 weeks | 
| Trunk Position Sense | Inclinometer will be positioned at spinous process of 1th thoracic vertebrae and 1 sacral during trunk position sense assessment. Subject will be retreated to neutral position and asked to come back taught position while eyes closed. Test will be repeated 3 times and angle of deviation from 30 degree flexion position will be recorded and the average of the results will be taken.As the deflection angle increases, the sense of position deteriorates. As the deflection angle increases, the sense of position deteriorates. | Change from baseline at 8 weeks | 
| Spinal mobility | Spinal Mouse device will be used to evaluate spinal mobility. Measurements will be made between the spinous process of the 7th cervical vertebra and approximately the level of the 3rd sacral vertebra. Maximum degrees of right-left lateral flexion in the frontal plane and maximum degrees of flexion-extension in the sagittal plane will be measured and recorded.As the degree increases, the deformity also increases. | Change from baseline at 8 weeks | 
| Fatique-Fatigue Severity Scale | The Fatigue Severity Scale, which rates the severity of fatigue symptoms, consists of questions expressing 9 different conditions.A high score indicates increased fatigue severity. Patients with a score of <4 will be considered not tired, and patients with a score of >4 will be considered tired. | Change from baseline at 8 weeks | 
| Fatigue- Fatigue Impact Scale | Each question ranges from 0 (no problem) to 4 (maximum problem) in the scale that evaluates cognitive status, physical condition and psychological status. High scores indicate fatigue. | Change from baseline at 8 weeks |