Treadmill training with virtual reality to enhance gait and cognitive function among people with multiple sclerosis: a randomized controlled trial

Abstract

Background 

Cognitive and motor impairments impact the everyday functioning of people with multiple sclerosis (pwMS). This randomized controlled trial (RCT)  evaluated the benefits of a combined virtual reality and motor–cognitive training program on critical cognitive and motor symptoms as well as related outcomes in people with multiple sclerosis. 

Methods 

In a single-blinded, two-arm RCT, 124 pwMS were randomized into a treadmill training with virtual reality (TT + VR) group or a treadmill training alone (TT) (active-control) group. For 6 weeks, each group received three training sessions per week. The primary outcomes were dual-tasking gait speed and cognitive processing speed (Symbol Digit Modalities Test, SDMT, score). Additional tests of cognitive function, mobility, and patient-reported questionnaires were secondary outcomes . Measurements were taken before, after, and three months after training. 

Results 

Gait speed improved (p < 0.005) similarly by about 10 cm/s in both groups. A clinically meaningful improvement of 4.4 points (95% CI 1.9–6.8, p = 0.001) in SDMT was shown in the TT + VR group (n = 53 analyzed per-protocol), compared to an improvement of only 0.8 points in the TT (n = 51 analyzed per-protocol) group (95% CI 0.9–2.5 points, p = 0.358) (group X time interaction effect p = 0.027). In addition, specific improvements were seen in depressive symptoms (lowered by 31%, p = 0.003), attention (17%, p < 0.001), and verbal fluency (11.6% increase, p = 0.002) in the TT + VR group. 

Discussion 

These findings suggest that both  TT + VR and TT improve usual and dual-task gait in people with multiple sclerosis. Furthermore, a VR based multi-modal approach positively impacts multiple aspects of cognitive function and mental health. This is more than seen after treadmill-training alone.