VR-Cognitive Games are Complementary to Physical training for an Optimum Rehabilitation Strategy in Multiple Sclerosis

Research Objectives: Growing evidence shows that physical rehabilitation is effective in improving both motor and cognitive symptoms of multiple sclerosis (MS). Yet, it is not clear whether cognitive improvements are greater in physical rehabilitation compared to cognitive rehabilitation programs. The aim of this randomized controlled trial was to compare physical with cognitive rehabilitation on cognition, and serum-derived blood markers in individuals with MS (iwMS).

Design: The physical rehabilitation protocol included a combination of endurance and resistance exercises. The VR cognitive rehabilitation program consisted of 3 newly created games targeting sensorimotor integration, memory-based navigation, and visual search.

Setting: Private practice at Physical Therapy Center, Department of Physical Education, University of Tehran.

Participants: Forty-eight iwMS, 31 females (65%), with age = median (Sd), 34.12 (8.5), and EDSS = 2.94 (0.92) were randomized to three groups: 18 received physical rehabilitation, 20 received VR-based cognitive rehabilitation, and 10 received no intervention.

Interventions: Each intervention lasted 8 weeks for three 1-hour sessions per week. (24 sessions)

Main Outcome Measures: Cognition was assessed using the Symbol Digit Modalities Test (SDMT) and the iPad-based Integrated Cognitive Assessment (ICA) test. BDNF and NfL were extracted from serum.

Results: Physical rehabilitation significantly improved physical performance factors [p value (EDSS)= 0.016, p (IGF-1) = 2.602e-8], as well as two cognitive performance factors [p(BDNF) = 3.903e-12, p(ICA)= 0.015]. On the other hand, cognitive rehabilitation significantly improved cognitive performance factors [p(BDNF) = 5.042e-15, p(ICA) = 0.001, p(SDMT) = 9.341e-6].

Conclusions: Cognitive rehabilitation showed greater effects on cognition and serum-derived blood markers compared to physical rehabilitation in iwMS. Thus, our results suggest a combination of both physical and cognitive rehabilitation may be best suited to effectively improve the disease trajectory for iwMS.

Author(s) Disclosures: Maryam Sadeghi, Mohammadreza Kordi, Mehdi Daemi, MohammadSina Ibrahimnejad Bashiri, Hannes Devos, Seyed Massood Nabavi, Seyed-Mahdi Khaligh-Razavi