Examining the Effects of Video-game Exercise on Mobility and Brain Plasticity in Individuals With Multiple Sclerosis

Study Overview
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Brief Summary
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Dance Dance Revolution (DDR) may offer an innovative and highly effective format for delivering exercise programs to people with multiple sclerosis (MS). It is a fun, engaging and interactive video game that requires players to move their feet to targets while matching the rhythm of a song. In addition, DDR, involving both aerobic exercise and cognitive training, is an ideal intervention for improving cognitive functioning in those with MS. The purpose of this pilot study is to examine the use of DDR as a novel and highly specific exercise intervention to improve mobility and cognition among individuals with MS.

Detailed Description
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Dance Dance Revolution (DDR) may offer an innovative and highly effective format for delivering exercise programs to people with MS. It is a fun, engaging and interactive video game that requires players to move their feet to targets while matching the rhythm of a song. In addition, DDR, involving both aerobic exercise and cognitive training, is an ideal intervention for improving cognitive functioning in those with MS. The purpose of this pilot study is to examine the use of DDR as a novel and highly specific exercise intervention to improve mobility and cognition among individuals with MS. We will be guided by the following three specific aims and hypotheses: Specific Aim 1: Determine if an eight-week exercise program administered using DDR improves dynamic balance in people with MS relative to a wait-list control group. Hypothesis 1: Dynamic balance as measured by the Berg Balance Scale will be more improved with the DDR intervention than the wait-list control group. Specific Aim 2: Determine if the DDR intervention, combining fitness and cognitive training, over the course of an eight-week intervention, will have a more positive effect on domains of processing speed and executive control, than a wait-list control group. Hypothesis 2: The DDR group relative to the wait-list control group, will show significant improvement in cognitive functioning as assessed by the Paced Auditory Serial Addition Test (PASAT), a measure of processing speed, and executive functioning. Specifically, we hypothesize that given severe deficits in processing speed and executive control, participation in a DDR intervention, will result in a significant improvement on the PASAT, a widely used measure to assess cognitive functioning in patients with MS. Specific Aim 3: We will also examine whether improvements in cognitive processes engendered by DDR on the PASAT will be supported by changes in underlying neural circuits, as inferred from patterns of event-related functional magnetic resonance imaging (fMRI) activation obtained in a 3 Tesla scanner. Hypothesis 3: Improvements in cognition as indexed by higher accuracy scores and faster reaction time on the PASAT, will be accompanied by a change in the recruitment of underlying neural processes as inferred from functional magnetic resonance imaging. MS participants in the DDR group will show an increase in recruitment of the attentional network, and more specifically the prefrontal and parietal cortices, cortical regions responsible for successful performance on the PASAT task.

Official Title
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Examining the Effects of Dance, Dance Revolution on Mobility, Brain Plasticity and Cognition in Individuals With Multiple Sclerosis

Conditions
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Multiple Sclerosis

Intervention / Treatment
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* Other: Dance Dance Revolution video game play


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Expanded Disability Status Score of < 5 and a diagnosis of relapsing-remitting multiple sclerosis Exclusion Criteria: other neurological or orthopedic diagnosis that limits ambulation, age 30-59

Ages Eligible for Study
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Minimum Age: 30 Years
Maximum Age: 59 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: Dance Dance Revolution game play<br>Dance Dance Revolution video game play | Other: Dance Dance Revolution video game play<br>* Individuals play dance dance revolution 3 times a week for 8 weeks<br>|
| No Intervention: control<br>individuals continue usual care for 8 weeks | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Berg Balance Scale | The Berg Balance scale consists of 14 functional activities that test static and dynamic balance. Each item is scored on a scale of 0-4 with higher scores indicating better balance | after 8 weeks | 
| PASAT | The PASAT is a measure of sustained attention, working memory and information processing speed. | after 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| 4 square step test | requires a person to step rapidly in a multi-directional pattern over a cane. It predicts fallers | after 8 weeks | 
| The Activities Specific Balance Confidence Scale | Measures fear of falling. Subjects rate their balance confidence on 10 items. | after 8 weeks | 
| GAITRite | individuals walk on a computerized carpet that records spatiotemporal aspects of gait such as velocity and stride length. | after 8 weeks | 
| 6 minute walk test | subjects walk for 6 minutes and distance walked is measured | Immediately prior to starting the intervention/control period,, after 8 week intervention/control period and then at an 8 week follow up | 
| physical activity | subjects wear an accelerometer for 5 days which records how active they are. | after 8 weeks | 
| multiple sclerosis quality of life inventory | the MS quality of life inventory is filled out to measure the impact of MS on the individuals quality of life. | after 8 weeks | 
| fMRI | individuals will go into an MRI and undergo neuropsychological and motor testing to examine for neuroplasticity | after 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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multiple sclerosis, mobility, cognition, neuroplasticity, videogame play