Motor Imagery Training in Persons With Multiple Sclerosis

Study Overview
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Brief Summary
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Motor imagery training facilitates the neural plasticity with increasing the neuronal cortical pathways in the brain. Motor imagery training is an effective way in stroke survivors. However, its effects in persons with multiple sclerosis (MS) are not known. Additionally, telerehabilitation based motor imagery training is very rare treatment way which requires more research. Therefore, this study aims to investigate the effect of telerehabilitation based motor imagery training on gait and balance performance of the persons with MS. The participants will be allocated into three groups, including motor imagery training, wait-list control group, and healthy control group. All the assessments will be performed before and after the training in the 8-week motor imagery training group. The participants in the control group will underwent the assessment with a 8-week interval. The healthy participants will be assessed only one. The motor imagery training will be designed for the individual basis with following standard protocols. It will be applied two times a week for 8 weeks. The first one and/or two sessions will be performed in the clinic, the other will be performed at the patients' home with a video-conference telerehabilitation technique.

Detailed Description
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Multiple sclerosis (MS) is a chronic, inflammatory, and demyelinating disease of the central nervous system. It is the most common neurological disease which causes progressive gait and balance disorders in young adults. The previous studies have indicated that home care and treatment services, which accelerates the healing process and makes the one feel better, are more preferred by the patients. Persons with MS are commonly not able to access the institutional rehabilitation services because of their disability and/or home location. It restricts the participation of the persons with MS and their treatment benefits. In recent years, the telerehabilitation programs are increasing to overcome this problem. Motor imagery training also stands as a good option in the rehabilitation programs. Motor imagery is a mental process by which an individual rehearses or simulates a given action. Motor imagery training facilitates the neural plasticity with increasing the neuronal cortical pathways in the brain. Motor imagery training is an effective way in stroke survivors. However, its effects in persons with MS are not known. Additionally, telerehabilitation based motor imagery training is very rare treatment way which requires more research. The aim of this study is to investigate the effect of telerehabilitation based motor imagery training on gait and balance performance of the persons with MS. The participants will be allocated into three groups, including motor imagery training group, control group, and healthy control group. The persons with MS will be recruited from the outpatient MS clinic of Dokuz Eylul University, and the healthy participants will be recruited from the stuff of Dokuz Eylul University. The inclusion and exclusion criteria assessments and the neurological examination will be performed by a blinded neurologist specialized in MS. The cognition, fatigue, depression, and quality of life assessment will be performed by a blinded neuropsychologist. The remaining assessments, including walking, balance, and motor imagery abilities will be assessed by a blinded physiotherapist. All the assessments will be performed before and after the training in the 8-week motor imagery training group. The participants in the control group will underwent the assessment with a 8-week interval. The healthy participants will be assessed only one. The motor imagery training will be designed for the individual basis with following standard protocols. It will be applied two times a week for 8 weeks. The first one and/or two sessions will be performed in the clinic, the other will be performed at the patients' home with a video-conference telerehabilitation technique.

Official Title
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The Effect of Telerehabilitation Based Motor Imagery Training on Gait and Balance Performance of the Persons With Multiple Sclerosis: A Randomized Controlled Trial

Conditions
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Multiple Sclerosis

Intervention / Treatment
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* Other: Motor imagery training


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Diagnosis of multiple sclerosis Having the Expanded Disability Status Scale 0 - 4.0 Relapse-free period at the last 3 months Enough computer use ability Having computer and internet connection Exclusion Criteria: Having severe musculoskeletal, cardiovascular, pulmonary, or metabolic disease Severe cognitive impairment Pregnancy

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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Accepts Healthy Volunteers

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: Motor imagery training<br>Persons with multiple sclerosis | Other: Motor imagery training<br>* The motor imagery training will be designed for the individual basis with following standard protocols. It will be applied two times a week for 8 weeks. The first one and/or two sessions will be performed in the clinic, the other will be performed at the patients' home with a video-conference telerehabilitation technique.<br>|
| No Intervention: Control group<br>Persons with multiple sclerosis | |
| No Intervention: Healthy controls<br>Healthy participants | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Dynamic Gait Index |  | Change from Baseline at 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Expanded Disability Status Scale |  | At Baseline | 
| Kinesthetic and Visual Imagery Questionnaire (KVIQ)-10 |  | Change from Baseline at 8 weeks | 
| Movement Imagery Questionnaire-Revised Second Edition (MIQ-RS) |  | Change from Baseline at 8 weeks | 
| Mental Chronometry for 2-Meter Walk Test |  | Change from Baseline at 8 weeks | 
| Mental Chronometry for 5-Meter Walk Test |  | Change from Baseline at 8 weeks | 
| Mental Chronometry for 10-Meter Walk Test |  | Change from Baseline at 8 weeks | 
| Mental Chronometry for Timed 25-Foot Walk |  | Change from Baseline at 8 weeks | 
| Mental Chronometry for Timed Up and Go Test |  | Change from Baseline at 8 weeks | 
| Mental Chronometry for Five Times Sit to Stand Test |  | Change from Baseline at 8 weeks | 
| 2-Meter Walk Test |  | Change from Baseline at 8 weeks | 
| 5-Meter Walk Test |  | Change from Baseline at 8 weeks | 
| 10-Meter Walk Test |  | Change from Baseline at 8 weeks | 
| Timed 25-Foot Walk |  | Change from Baseline at 8 weeks | 
| 2-Minute Walk Test |  | Change from Baseline at 8 weeks | 
| Twelve Item MS Walking Scale |  | Change from Baseline at 8 weeks | 
| Timed Up and Go Test |  | Change from Baseline at 8 weeks | 
| Five Times Sit to Stand Test |  | Change from Baseline at 8 weeks | 
| Curl-up Test |  | Change from Baseline at 8 weeks | 
| Activities-specific Balance Confidence Scale |  | Change from Baseline at 8 weeks | 
| Postural Stability Test by Balance System™ |  | Change from Baseline at 8 weeks | 
| The Limits of Stability Test by Balance System™ |  | Change from Baseline at 8 weeks | 
| Fall Risk Test by Balance System™ |  | Change from Baseline at 8 weeks | 
| Modified Fatigue Impact Scale |  | Change from Baseline at 8 weeks | 
| Hospital Anxiety and Depression Scale |  | Change from Baseline at 8 weeks | 
| Multiple Sclerosis International Quality of Life Questionnaire |  | Change from Baseline at 8 weeks | 
| Symbol Digit Modalities Test |  | Change from Baseline at 8 weeks | 
| Selective Reminding Test |  | Change from Baseline at 8 weeks | 
| 10/36 Spatial Recall Test |  | Change from Baseline at 8 weeks |