Combined Motor Imagery and Vestibular Rehab for MS

N/ANot Yet RecruitingNCT07230015

Medipol University30 enrolled

Overview

This trial investigates the first combined use of motor imagery and vestibular rehabilitation in multiple sclerosis, aiming to evaluate their joint effect on balance, cognition, and quality of life.

Multiple sclerosis often causes balance disturbance, cognitive decline, and reduced quality of life. Motor imagery and vestibular rehabilitation are established methods in MS care, but their effects have only been studied separately. This randomized controlled trial introduces a combined program of motor imagery and vestibular training to explore whether their integration provides broader benefits. The study will recruit patients with relapsing-remitting MS, apply an 8-week intervention, and compare outcomes in cognition, balance, physical performance, and quality of life against conventional therapy.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Multiple Sclerosis (MS) - Relapsing-remitting

Interventions

Motor Imagery + Vestibular Rehabilitation groupBEHAVIORAL

This 8-week program, 3 sessions/week, 55- 60 min each, includes 4 steps: Warm-up (5 min): Breathing exercises progressing from basic diaphragmatic and pursed-lip breathing (weeks 1-2), light movement with breathing (weeks 3-4), to Inspiratory Muscle Training device (weeks 5-8). Motor Imagery (15 min): Foundational phase (weeks 1-2) imagining basic movements, skills building (weeks 3-4) with functional daily tasks, advanced phase (weeks 5-8) imagining complex tasks, environmental and cognitive challenges (e.g., sports, obstacle navigation, walking on uneven surfaces). Vestibular Rehabilitation (15 min): Foundational (weeks 1-2) gaze stabilization and static balance (VOR, VSR, VCR), dynamic balance and dual-task exercises (weeks 3-6), advanced functional balance and vestibular-cognition integration (weeks 7-8). Cool-down (10 min): Relaxation and symptom monitoring to prevent overexertion, dizziness, or fatigue.

Conventional therapy groupBEHAVIORAL

This 8-week program, 3 sessions/week, 55- 60 min each, includes: Warm-up: Seated/standing marching, neck and shoulder stretching. Strength \& Functional Movements: Sit-to-stand, side leg raises, step-ups. Core \& Upper Body: Bridge exercise, seated core activation, seated leg lifts, wall push-ups, seated shoulder press. Flexibility \& Balance: Calf and hamstring stretches, spinal flexibility, single-leg stance, lunges, tandem walking. Cool-down: Deep breathing and gentle stretching.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 45 Years

Medical Language ↔ Plain English

inclusion criteria 1. Diagnosis of Multiple Sclerosis (MS) Confirmed using McDonald Criteria 2. Patient diagnosed relapsing-remitting multiple sclerosis (RRMS). 3. Mild MS between 0-3 according to PDDS. 4. Age from (18-45) 5. Mild cognitive impairment 6. Balance impairment (mild to moderate impairment) 7. Vestibular dysfunction Related to MS (dizziness, vertigo , gaze instability ) 8. Native language is Arabic to ensure clear communication during cognitive tasks and exercise instructions 9\. Be able to joined the treatment (motor imagery, vestibular rehabilitaiton ) Exclusion Criteria: Other neurological disorder, progressive multiple sclerosis Non-MS related vestibular disorders (e.g., BPPV, Meniere's disease) that would interfere with vestibular rehab. Severe Psychiatric Conditions (schizophrenia, bipolar, etc) Sever balance disorder Sever fatigue Medical instability eg (cardiovascular disease, respiratory, infections, severe uncontrolled diabetes, or severe visual impairments.) Sever cognitive impairment Pregnant Advance disability ( wheelchair , unable to stand ) Use of Vestibular-Suppressing Medications Non - speaker Arabic

Locations (1)

Gehad Salem Mohamed Mohamed Menshawi

Istanbul, Beykoz/İstanbul, Turkey (Türkiye)

Outcomes

Primary Outcomes

Change in Cognitive Function (Montreal Cognitive Assessment [MoCA] Score)

It is a cognitive screening tool commonly used in clinics and research to assess individual cognitive impairment and its severity. It helps therapists evaluate a patient's cognitive function and identify changes over time by assessing mental capacity functions and takes about 10-15 minutes to complete., which includes Attention \& Concentration, Executive Functions, Memory, Language, Visuospatial Skills and Orientation (19). 1. The test is scored out of 30 points. 2. A score of 26 or higher is considered normal. 3. Scores below 26 may indicate mild cognitive impairment or early dementia.

Time frame: Baseline and 8 weeks after intervention

Change in Balance Berg Balance Scale \[ABBS] Score)

To assess balance and fall risk in Arabic-speaking patients with neurological disorders, lower scores indicate more severe balance problems (23). 1. 41-56: Low fall risk, good balance. 2. 21-40: Moderate fall risk. 3. 0-20: High fall risk."

Time frame: Baseline (Week 0) and Post-intervention (Week 8)

Change in Vestibular Function (Dynamic Visual Acuity [DVA] Test)

DVA assesses visual acuity during head movement to evaluate vestibulo-ocular reflex integrity.It is a functional test designed to evaluate the integrity of the vestibulo-ocular reflex (VOR), which stabilizes the eyes during head motion. DVA is commonly employed to detect vestibular dysfunction and is particularly useful for evaluating vestibular function in patients experiencing dizziness, balance disorders, or conditions such as multiple sclerosis (MS), where vestibular dysfunction is common

Time frame: Baseline and Week 8.

Change in Vestibular Function (Head Impulse Test [HIT])

Bedside assessment of semicircular canal/VOR function. Outcome recorded as presence/absence of corrective saccades and qualitative clinician rating of gain; improvement indicates better vestibular function.It is a clinical test used to identify deficits in the semicircular canals, especially the horizontal canal, and is useful for detecting peripheral vestibular deficits. It assesses the ability of the vestibulo-ocular reflex (VOR) to maintain stable vision during rapid, unpredictable head movements