This randomized controlled trial investigated the effects of sequential laterality, motor imagery, and mental rotation training in individuals with relapsing-remitting multiple sclerosis. Both groups received conventional physiotherapy, while the intervention group received structured cognitive-motor training and the control group received active visual-attention training.
Fifty-four participants were randomly assigned to the intervention or control group. Both groups received 45-minute sessions three times per week for six weeks. Mental rotation ability was the primary outcome, while upper-extremity function, manual ability, motor imagery, grip strength, dexterity, and information-processing speed were assessed as secondary outcomes. Assessments were performed before and after the intervention by a researcher blinded to group allocation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
54
Participants received 30 minutes of conventional physiotherapy followed by 15 minutes of structured training, three times per week for six weeks. The training progressed sequentially through laterality recognition, motor imagery, and mental rotation. Laterality training involved identifying right- and left-hand images. Motor imagery training involved imagining the hand positions and movements shown in the images without performing an observable movement. Mental rotation training involved mentally rotating figures and selecting the correct response.
Participants received 30 minutes of conventional physiotherapy followed by 15 minutes of active visual-attention control training, three times per week for six weeks. The training included images of neutral objects, colors, geometric shapes, and symbols that did not depict body parts. Participants classified the images according to color, shape, size, position, or similarity and difference.
Abant Izzet Baysal University Faculty of Health Science
Bolu, Turkey (Türkiye)
The Purdue Spatial Visualization Test
The Purdue Spatial Visualization Test a widely used mental rotation tests, consists of 30 three-dimensional spatial perception questions.
Time frame: Baseline and immediately after the 6-week intervention.
The Symbol Digit Modalities Test
The Symbol Digit Modalities Test is a widely used assessment tool for measuring information-processing speed in patients with MS.
Time frame: Baseline and immediately after the 6-week intervention.
Nine-Hole Peg Test
In the Nine-Hole Peg Test, nine wooden pegs were placed into a wooden board containing nine holes using one hand.
Time frame: Baseline and immediately after the 6-week intervention.
Kinesthetic and Visual Imagery Questionnaire
Motor imagery ability was evaluated and scored using 20 items examining movements of different body parts in a sitting position, with two subscales assessing kinesthetic and visual imagery abilities. The total score ranges from 10 to 50, with each subscale ranging from 5 to 25.
Time frame: Baseline and immediately after the 6-week intervention.
Grip Strength
Grip strength was assessed using a Jamar hand dynamometer.
Time frame: Baseline and immediately after the 6-week intervention
Abilhand
Abilhand is a patient-reported scale used to determine the perceived level of difficulty individuals experience when using their hands during activities of daily living. The Abilhand total raw score ranges from 0 to 46, with higher scores indicating better self-perceived manual ability in performing daily bimanual activities.
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Time frame: Baseline and immediately after the 6-week intervention.
The Action Research Arm Test (ARAT)
The Action Research Arm Test was used to evaluate upper extremity functional capacity and consists of four subdomains: grasp, grip, pinch, and gross movement.
Time frame: Baseline and immediately after the 6-week intervention.