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Munari D1, Fonte C2, Varalta V2, Battistuzzi E2, Gandolfi M1,2, Montagnoli AP2, Smania N1,2, Picelli A1,2
1Neurorehabiltiation Ward, Department of Neurosciences, Hospital Trust Verona, Verona, Italy, 2Neuromotor and Cognitive Rehabilitation Center, Department for Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
Background: Multiple Sclerosis (MS) is an inflammatory autoimmune disorder of the Central Nervous System (CNS) resulting in axonal demyelination and neuronal dysfunction. These structural and functional changes have sensory, motor and cognitive consequences leading to a progressive disability. Cognitive deficits are very common in individuals with MS ranging from 40% to 70% of patients, documented at many stages of the disease. An emerging field in rehabilitation pertains to the role of rehabilitation for managing cognitive impairment in persons with MS. In the last decade, studies have been published on the effects of Robot Assisted Gait Training (RAGT) in MS reporting positive findings on gait, balance and quality of life. Nevertheless, not all trials have included cognition as an outcome variable and therefore it is difficult to determine the effect of the RAGT on cognitive impairment from these studies.
Purpose: The main purpose of this study was to compare the effects of an innovative combined RAGT plus Virtual Reality (RAGT+VR) with those of standard RAGT on cognitive impairments and motor deficits in patients with MS.
Methods: A Single-blind, pilot randomized controlled trial was conducted by Neurorehabilitation Ward, University Hospital of Verona, Italy. Subjects were enrolled and randomly allocated either in the RAGT- VR or in the RAGT group: the RAGT-VR group underwent a training on an end-effector device combine with VR while the RAGT group underwent a training on an end-effector device alone. Each patient, irrespective of group assignment, underwent individualized treatment 40-minute/day, two days/week for six consecutive weeks for a total of 12 sessions. A blinded rater evaluated patients before, after treatment, and at one month follow-up. Primary outcome was the Paced Auditory Serial Addition Test (PASAT). Secondary outcomes were the Phonemic Fluency Test (PFT), Rivermead Behavioral Memory Test (RBMT), Digit Symbol (DSymb), Multiple Sclerosis Quality of Life-54 (MSQOL-54), Two Minute Walking Test (2MWT), 10 Meter Walking Test (10MWT), Berg Balance Scale (BBS), gait analysis and stabilometric assessment.
Results: Seventeen MS patients (7 males and 10 females) were randomized to the RAGT-VR group (n =8) or the RAGT group (n =9). At baseline no significant differences were noted.
Between groups comparisons showed significant change in 2MWT after treatment (p=0.012).
In the RAGT-VR group, within-group comparison showed significant improvements after treatment and at follow-up in PASAT (p=0.012; p=0.012), PFT (p=0.012; p=0.012). and RBMT NT-IR (p=0.012; p=0.012). Significant improvements after treatment were found on MSQOL-54 PHC composite (p=0.017), MSQOL-54 MHC composite (p=0.018), 2MWT (p=0.012), 10MWT (p=0.012) and BBS (p=0.011).
In the RAGT group significant improvements were found for MSQOL-54 MHC (p=0.018), MSQOL-54 PHC (p=0.017), 10MWT (p=0.018) and BBS (p=0.016) after treatment.
Conclusion(s): RAGT combine with VR could be considered a novelty training and more effective on improving gait abilities compare to RAGT alone. Further studies on larger patients samples are warranted to confirm these preliminary findings.
Implications: Repetitive newly learned movements may influence cognitive functions in MS patients and RAGT can improve information processing speed, sustained attention and working memory. These results provide a basis for a larger randomized controlled trial.
Keywords: Rehabilitation, executive functions, robot-assisted gait training
Funding acknowledgements: No findings were obtained to conduct the study.
Purpose: The main purpose of this study was to compare the effects of an innovative combined RAGT plus Virtual Reality (RAGT+VR) with those of standard RAGT on cognitive impairments and motor deficits in patients with MS.
Methods: A Single-blind, pilot randomized controlled trial was conducted by Neurorehabilitation Ward, University Hospital of Verona, Italy. Subjects were enrolled and randomly allocated either in the RAGT- VR or in the RAGT group: the RAGT-VR group underwent a training on an end-effector device combine with VR while the RAGT group underwent a training on an end-effector device alone. Each patient, irrespective of group assignment, underwent individualized treatment 40-minute/day, two days/week for six consecutive weeks for a total of 12 sessions. A blinded rater evaluated patients before, after treatment, and at one month follow-up. Primary outcome was the Paced Auditory Serial Addition Test (PASAT). Secondary outcomes were the Phonemic Fluency Test (PFT), Rivermead Behavioral Memory Test (RBMT), Digit Symbol (DSymb), Multiple Sclerosis Quality of Life-54 (MSQOL-54), Two Minute Walking Test (2MWT), 10 Meter Walking Test (10MWT), Berg Balance Scale (BBS), gait analysis and stabilometric assessment.
Results: Seventeen MS patients (7 males and 10 females) were randomized to the RAGT-VR group (n =8) or the RAGT group (n =9). At baseline no significant differences were noted.
Between groups comparisons showed significant change in 2MWT after treatment (p=0.012).
In the RAGT-VR group, within-group comparison showed significant improvements after treatment and at follow-up in PASAT (p=0.012; p=0.012), PFT (p=0.012; p=0.012). and RBMT NT-IR (p=0.012; p=0.012). Significant improvements after treatment were found on MSQOL-54 PHC composite (p=0.017), MSQOL-54 MHC composite (p=0.018), 2MWT (p=0.012), 10MWT (p=0.012) and BBS (p=0.011).
In the RAGT group significant improvements were found for MSQOL-54 MHC (p=0.018), MSQOL-54 PHC (p=0.017), 10MWT (p=0.018) and BBS (p=0.016) after treatment.
Conclusion(s): RAGT combine with VR could be considered a novelty training and more effective on improving gait abilities compare to RAGT alone. Further studies on larger patients samples are warranted to confirm these preliminary findings.
Implications: Repetitive newly learned movements may influence cognitive functions in MS patients and RAGT can improve information processing speed, sustained attention and working memory. These results provide a basis for a larger randomized controlled trial.
Keywords: Rehabilitation, executive functions, robot-assisted gait training
Funding acknowledgements: No findings were obtained to conduct the study.
Topic: Neurology; Robotics & technology
Ethics approval required: Yes
Institution: Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
Ethics committee: CESC Ethic committee
Ethics number: 1054CESC
All authors, affiliations and abstracts have been published as submitted.
