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From ECTRIMS 2018
The effects of an innovative combined Robot Assisted Gait Training and Virtual Reality on cognitive impairments and motor deficits in patients with multiple sclerosis: a pilot randomized control trial
D. Munari1, C. Fonte2, V. Varalta2, E. Battistuzzi2, M. Gandolfi2, A.P. Montagnoli2, N. Smania1, A. Picelli2 1Department of Neurosciences, Hospital Trust Verona, Neurorehabilitation Unit, 2Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre, University of Verona, Verona, Italy
Background: Cognitive impairments affect up to 70% of persons with Multiple Sclerosis (MS) and the potential of gait rehabilitation with Virtual Reality (VR) to reduce clinical symptoms and disability due to cognitive deficits might be very promising. The main aim of this pilot randomized controlled trial was to compare the effects of an innovative combined Robot Assisted Gait Training plus VR (RAGT-VR) with those of standard RAGT on cognitive impairments and motor deficits in patients with Multiple Sclerosis (MS).
Methods: 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) and Two Minute Walking Test (2MWT), 10 Meter Walking Test (10MWT) and Berg Balance Scale (BBS).
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 favor of RAGT-VR group. In the RAGT-VR group, within-group comparison showed significant improvements after treatment and at follow-up on 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: RAGT combine with VR could be consider a novelty training and more effective on improving gait abilities compare to RAGT alone and could ameliorated cognitive impairments in subjects suffering from MS. Further studies on larger patients samples are warranted to confirm these preliminary findings.
The effects of an innovative combined Robot Assisted Gait Training and Virtual Reality on cognitive impairments and motor deficits in patients with multiple sclerosis: a pilot randomized control trial
D. Munari1, C. Fonte2, V. Varalta2, E. Battistuzzi2, M. Gandolfi2, A.P. Montagnoli2, N. Smania1, A. Picelli2 1Department of Neurosciences, Hospital Trust Verona, Neurorehabilitation Unit, 2Department of Neurosciences, Biomedicine and Movement Sciences, Neuromotor and Cognitive Rehabilitation Research Centre, University of Verona, Verona, Italy
Background: Cognitive impairments affect up to 70% of persons with Multiple Sclerosis (MS) and the potential of gait rehabilitation with Virtual Reality (VR) to reduce clinical symptoms and disability due to cognitive deficits might be very promising. The main aim of this pilot randomized controlled trial was to compare the effects of an innovative combined Robot Assisted Gait Training plus VR (RAGT-VR) with those of standard RAGT on cognitive impairments and motor deficits in patients with Multiple Sclerosis (MS).
Methods: 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) and Two Minute Walking Test (2MWT), 10 Meter Walking Test (10MWT) and Berg Balance Scale (BBS).
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 favor of RAGT-VR group. In the RAGT-VR group, within-group comparison showed significant improvements after treatment and at follow-up on 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: RAGT combine with VR could be consider a novelty training and more effective on improving gait abilities compare to RAGT alone and could ameliorated cognitive impairments in subjects suffering from MS. Further studies on larger patients samples are warranted to confirm these preliminary findings.